Healthcare Provider Details

I. General information

NPI: 1396734513
Provider Name (Legal Business Name): ANTHONY NEAL GREGORY MD MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1547 COLUMBIA TPKE
CASTLETON NY
12033-9543
US

IV. Provider business mailing address

1547 COLUMBIA TPKE
CASTLETON NY
12033-9543
US

V. Phone/Fax

Practice location:
  • Phone: 518-479-4156
  • Fax: 518-479-3794
Mailing address:
  • Phone: 518-477-7130
  • Fax: 518-694-5322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number173589
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberME121388
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number173589
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberME121388
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: