=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730200650
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PAUL LAWRENCE GREGORY DDS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/02/2007
-----------------------------------------------------
Last Update Date | 06/23/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 57 W 57TH ST STE 804
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10019-2808
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-826-0505
-----------------------------------------------------
Fax | 212-593-1283
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 372 CENTRAL PARK WEST APT.#4Y
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10025
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-663-9105
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 043894
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------