Healthcare Provider Details

I. General information

NPI: 1013372135
Provider Name (Legal Business Name): WINTHROP FACULTY MEDICAL AFFILIATES UNIVERSITY FACULTY PRACTICE CORPOR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2015
Last Update Date: 12/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 MINEOLA BLVD SUITE 300
MINEOLA NY
11501-4064
US

IV. Provider business mailing address

700 HICKSVILLE RD SUITE 204
BETHPAGE NY
11714-3471
US

V. Phone/Fax

Practice location:
  • Phone: 516-663-4400
  • Fax: 516-663-4404
Mailing address:
  • Phone: 516-576-1841
  • Fax: 516-576-5801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number
License Number State

VIII. Authorized Official

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