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NPI Code Detail

MEDICARE: JUSTIN BARTOLO GREGES PA-C

MEDICARE: JUSTIN BARTOLO GREGES PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant013018NY

General Provider Information

NPI Number : 1770738569
Entity Type Code : Individual
Provider Name (Legal Business Name) : JUSTIN BARTOLO GREGES PA-C
Provider Business Mailing Address
First Line : 200 CHRISTOPHER COLUMBUS DR
Second Line : A3
City : JERSEY CITY
State : NJ
Zip : 07302-3483
Country : US
Telephone Number : 201-320-0498
Fax Number :
Provider Business Practice Location Address
First Line : 200 CHRISTOPHER COLUMBUS DR
Second Line : A3
City : JERSEY CITY
State : NJ
Zip : 07302-3483
Country : US
Telephone Number : 201-320-0498
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/21/2008
Last Update Date : 11/21/2008

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