Healthcare Provider Details

I. General information

NPI: 1578786141
Provider Name (Legal Business Name): BRYAN JAMES MCGREAL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

324 LAFAYETTE ST FL 8
NEW YORK NY
10012-2726
US

IV. Provider business mailing address

470 W 24TH ST APT 15J
NEW YORK NY
10011-1238
US

V. Phone/Fax

Practice location:
  • Phone: 212-533-4040
  • Fax: 212-625-1534
Mailing address:
  • Phone: 212-229-2078
  • Fax: 212-625-1534

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number185477
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: