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General NPI Number Information
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NPI Number | 1508336751
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Entity Type | Individual
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Provider Name | STEPHANIE GREGG
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Gender | Female
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Dates
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Enumeration Date | 11/30/2018
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Last Update Date | 11/30/2018
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Provider Practice Location Address
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Address Line | 1 GUSTAVE L LEVY PL
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City | NEW YORK
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State | NY
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Zip | 10029-6504
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Country | US
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Telephone | 347-638-4286
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Fax |
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Provider Business Mailing Address
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Address Line | 65 ROOSEVELT AVE
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City | HASBROUCK HEIGHTS
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State | NJ
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Zip | 07604-1009
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Country | US
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Telephone |
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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 | 1835P1200X
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Taxonomy Name | Pharmacotherapy Pharmacist
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License Number | 061221
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License Number State | NY
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