Provider Demographics
NPI:1740249184
Name:GRECO, MICHAEL (PHD, CRNA, AGACNP-BC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:GRECO
Suffix:
Gender:M
Credentials:PHD, CRNA, AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 COMMUNITY DR STE 300
Mailing Address - Street 2:
Mailing Address - City:MANHASSET
Mailing Address - State:NY
Mailing Address - Zip Code:11030-3818
Mailing Address - Country:US
Mailing Address - Phone:929-308-1689
Mailing Address - Fax:212-289-6929
Practice Address - Street 1:600 COMMUNITY DR STE 300
Practice Address - Street 2:
Practice Address - City:MANHASSET
Practice Address - State:NY
Practice Address - Zip Code:11030-3818
Practice Address - Country:US
Practice Address - Phone:516-463-7371
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-23
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9216546367500000X
NY462471-1367500000X
NY462471367500000X
NYF432324363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Single Specialty
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG4006OtherBCBS
FL307805100Medicaid
FL307805100Medicaid
NY33025FMedicare ID - Type Unspecified
FLAA047UMedicare PIN