Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | 198594 | NY |
Y | 213ES0000X | Sports Medicine | 198594 | NY |
NPI | 1467504076 |
---|---|
Provider Name | Dr. Joseph Gregorace |
First Address | Westbury, NY 11590-1831 |
Second Address | Bellmore, NY 11710-5709 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G14802 | (02) | NY |