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General NPI Number Information
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NPI Number | 1083191837
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Entity Type | Individual
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Provider Name | CHRISTOPHER JOSEPH GREGORY MED, ATC
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Gender | Male
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Dates
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Enumeration Date | 07/24/2018
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Last Update Date | 12/05/2022
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Provider Practice Location Address
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Address Line | 631 HOWARD AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10301-4422
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Country | US
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Telephone | 718-390-3100
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Fax |
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Provider Business Mailing Address
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Address Line | 14 SAGEBRUSH LN
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City | KINGS PARK
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State | NY
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Zip | 11754-3934
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Country | US
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Telephone | 631-873-5605
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 104.0133074
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License Number State | VT
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Taxonomy #2
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 0126002623
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 003996
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License Number State | NY
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