Healthcare Provider Details

I. General information

NPI: 1043206923
Provider Name (Legal Business Name): GREGORY F. DAVIES DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2005
Last Update Date: 09/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 JERICHO TPKE SUITE 300
SYOSSET NY
11791-4532
US

IV. Provider business mailing address

175 JERICHO TPKE SUITE 300
SYOSSET NY
11791-4532
US

V. Phone/Fax

Practice location:
  • Phone: 516-496-7676
  • Fax: 516-496-0422
Mailing address:
  • Phone: 516-496-7676
  • Fax: 516-496-0422

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberN003180
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code213ES0000X
TaxonomySports Medicine Podiatrist
License NumberN003180
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberN003180
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: