Healthcare Provider Details

I. General information

NPI: 1962808907
Provider Name (Legal Business Name): WINTHROP FACULTY MEDICAL AFFILIATES UNIVERSITY FACULTY PRACTICE CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2014
Last Update Date: 06/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 STATION PLZ N SUITE 518
MINEOLA NY
11501-3800
US

IV. Provider business mailing address

700 HICKSVILLE RD 204
BETHPAGE NY
11714-3471
US

V. Phone/Fax

Practice location:
  • Phone: 516-663-2588
  • Fax:
Mailing address:
  • Phone: 516-576-5810
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH GRECO
Title or Position: CO-PRESIDENT
Credential: MD
Phone: 516-663-2216