Healthcare Provider Details

I. General information

NPI: 1548757958
Provider Name (Legal Business Name): GERARD DEGREGORIS III, MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2018
Last Update Date: 04/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 E 57TH ST STE 610
NEW YORK NY
10022-2129
US

IV. Provider business mailing address

115 E 57TH ST STE 610
NEW YORK NY
10022-2129
US

V. Phone/Fax

Practice location:
  • Phone: 212-535-3505
  • Fax: 212-535-3568
Mailing address:
  • Phone: 212-535-3505
  • Fax: 212-535-3568

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number251334
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207LH0002X
TaxonomyHospice and Palliative Medicine (Anesthesiology) Physician
License Number251334
License Number StateNY

VIII. Authorized Official

Name: GERARD DEGREGORIS III
Title or Position: OWNER
Credential: MD
Phone: 212-535-3505