Healthcare Provider Details

I. General information

NPI: 1932667862
Provider Name (Legal Business Name): GREGORY ARIC WYCHE RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/11/2019
Last Update Date: 11/14/2025
Certification Date: 11/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

523 W 160TH ST APT 1B
NEW YORK NY
10032-6626
US

IV. Provider business mailing address

523 W 160TH ST APT 1B
NEW YORK NY
10032-6626
US

V. Phone/Fax

Practice location:
  • Phone: 917-446-6964
  • Fax:
Mailing address:
  • Phone: 917-446-6964
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number433386
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number716259
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: