Healthcare Provider Details

I. General information

NPI: 1477709020
Provider Name (Legal Business Name): GREGORY F. DAVIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2008
Last Update Date: 10/29/2008
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 Code261QP1100X
TaxonomyPodiatric Clinic/Center
License NumberN003180
License Number StateNY

VIII. Authorized Official

Name: PATRICIA CAVALLARO
Title or Position: OFFICE MANAGER
Credential:
Phone: 516-496-7676