Healthcare Provider Details

I. General information

NPI: 1659402030
Provider Name (Legal Business Name): GIACINTO GRIECO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 12/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

462 FIRST AVE - SEVENTH FLOOR NYU LANGONE HEALTH
NEW YORK NY
11016
US

IV. Provider business mailing address

2 LENOX CT
FORT LEE NJ
07024-1809
US

V. Phone/Fax

Practice location:
  • Phone: 646-501-6823
  • Fax:
Mailing address:
  • Phone: 201-947-6599
  • Fax: 201-947-3511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0301X
TaxonomyBrain Injury Medicine (Psychiatry & Neurology) Physician
License Number134960
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number134960
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number134960
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: