Provider Demographics
NPI:1770738569
Name:GREGES, JUSTIN BARTOLO (PA-C)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:BARTOLO
Last Name:GREGES
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 CHRISTOPHER COLUMBUS DR
Mailing Address - Street 2:A3
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07302-3483
Mailing Address - Country:US
Mailing Address - Phone:201-320-0498
Mailing Address - Fax:
Practice Address - Street 1:200 CHRISTOPHER COLUMBUS DR
Practice Address - Street 2:A3
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07302-3483
Practice Address - Country:US
Practice Address - Phone:201-320-0498
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-21
Last Update Date:2008-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013018363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant