Healthcare Provider Details

I. General information

NPI: 1124050471
Provider Name (Legal Business Name): GREGORY LAW MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 12/15/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 S WASHINGTON AVE
BERGENFIELD NJ
07621-4323
US

IV. Provider business mailing address

12 RAILROAD PL
BELLEVILLE NJ
07109-3413
US

V. Phone/Fax

Practice location:
  • Phone: 201-384-0036
  • Fax:
Mailing address:
  • Phone: 973-759-8002
  • Fax: 973-759-7545

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25MA07972500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: