Healthcare Provider Details

I. General information

NPI: 1063738797
Provider Name (Legal Business Name): GREGORY 'GREG' PROCOPIO N.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2010
Last Update Date: 08/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 CHARLANE PARKWAY
NORTH SYRACUSE NY
13212
US

IV. Provider business mailing address

PO BOX 3841
SYRACUSE NY
13220-3841
US

V. Phone/Fax

Practice location:
  • Phone: 315-706-5272
  • Fax:
Mailing address:
  • Phone: 315-706-5272
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number596534
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3366365
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: