Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207VX0201X | Gynecologic Oncologist | 033383 | CT |
Y | 207VX0201X | Gynecologic Oncologist | 174596-1 | NY |
NPI | 1376593301 |
---|---|
Provider Name | Dr. Herbert Gretz III |
First Address | Purchase, NY 10577-2574 |
Second Address | Purchase, NY 10577-2574 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2006 |
Last Update Date | 22/01/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01398801 | (05) | NY |
77H691 | EMPIRE BCBS (01) | NY |
F00438 | (02) | NY |