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General NPI Number Information
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NPI Number | 1689102055
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Entity Type | Individual
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Provider Name | MICHAEL V GREICO JR. PA
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Gender | Male
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Dates
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Enumeration Date | 05/31/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1700 N 10TH ST
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City | MILLVILLE
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State | NJ
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Zip | 08332-2042
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Country | US
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Telephone | 856-327-6446
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Fax | 856-327-0158
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Provider Business Mailing Address
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Address Line | 1700 N 10TH ST
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City | MILLVILLE
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State | NJ
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Zip | 08332-2042
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Country | US
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Telephone | 856-327-6446
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Fax | 856-327-0158
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 25MP00424800
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License Number State | NJ
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