Provider Demographics
NPI:1336425552
Name:GRECO, MOLLY ELIZABETH (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:MOLLY
Middle Name:ELIZABETH
Last Name:GRECO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:MOLLY
Other - Middle Name:ELIZABETH
Other - Last Name:CRONIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:399 ALBANY SHAKER RD
Mailing Address - Street 2:
Mailing Address - City:LOUDONVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12211-1961
Mailing Address - Country:US
Mailing Address - Phone:518-434-9759
Mailing Address - Fax:518-436-9822
Practice Address - Street 1:5792 WIDEWATERS PKWY
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13214
Practice Address - Country:US
Practice Address - Phone:315-703-3050
Practice Address - Fax:315-802-4688
Is Sole Proprietor?:No
Enumeration Date:2011-11-02
Last Update Date:2019-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015275-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant