Healthcare Provider Details

I. General information

NPI: 1457988990
Provider Name (Legal Business Name): JONATHAN GRECCO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2020
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 CROSS ST STE 200A
NORWALK CT
06851-4600
US

IV. Provider business mailing address

100 TRESSER BLVD APT 1524
STAMFORD CT
06901-3396
US

V. Phone/Fax

Practice location:
  • Phone: 203-852-2740
  • Fax:
Mailing address:
  • Phone: 914-450-5954
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number83056
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: