Healthcare Provider Details

I. General information

NPI: 1619637402
Provider Name (Legal Business Name): GREGORY WILLIAM AGNEW L.AC, LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/21/2021
Last Update Date: 11/09/2025
Certification Date: 11/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

63 AUDREY AVE
OYSTER BAY NY
11771-1503
US

IV. Provider business mailing address

22 LINCOLN PL
GLEN COVE NY
11542-1949
US

V. Phone/Fax

Practice location:
  • Phone: 516-857-3723
  • Fax: 516-674-9031
Mailing address:
  • Phone: 516-857-3723
  • Fax: 516-674-9031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number007033
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number019277
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: