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General NPI Number Information
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NPI Number | 1104034362
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Entity Type | Organization
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Legal Business Name | GREGORY P COLLIS
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Dates
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Enumeration Date | 05/20/2007
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Last Update Date | 06/16/2008
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Provider Practice Location Address
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Address Line | 212 HIGHLAND ST
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City | SYRACUSE
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State | NY
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Zip | 13203-1603
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Country | US
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Telephone | 315-382-6725
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Fax |
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Provider Business Mailing Address
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Address Line | 212 HIGHLAND ST
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City | SYRACUSE
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State | NY
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Zip | 13203-1603
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Country | US
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Telephone | 315-382-6725
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Fax |
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Authorized Official
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Title or Position | OPERATOR
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Name | MR. GREGORY PAUL COLLIS
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Credential |
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Telephone | 315-382-6725
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 0824A002
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License Number State | NY
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