Healthcare Provider Details

I. General information

NPI: 1114961703
Provider Name (Legal Business Name): ANDREW PAUL THOMAS GREGORY D.C., FNP-C, R.NCS.T
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 07/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

460 HARTFORD TPKE
VERNON CT
06066-4845
US

IV. Provider business mailing address

460 HARTFORD TPKE
VERNON CT
06066-4845
US

V. Phone/Fax

Practice location:
  • Phone: 860-872-6229
  • Fax:
Mailing address:
  • Phone: 860-872-6229
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License Number001133
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number118083
License Number StateCT
# 4
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number6561
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: