1013118660 NPI number — DR. JOHN ANTHONY GREGG D.O.

Table of content: DR. JOHN ANTHONY GREGG D.O. (NPI 1013118660)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013118660 NPI number — DR. JOHN ANTHONY GREGG D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GREGG
Provider First Name:
JOHN
Provider Middle Name:
ANTHONY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013118660
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/27/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
510 HAMBURG TPKE
Provider Second Line Business Mailing Address:
WAYNE COMMONS, SUITE 101
Provider Business Mailing Address City Name:
WAYNE
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07470-2025
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-942-6005
Provider Business Mailing Address Fax Number:
973-942-6009

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
510 HAMBURG TPKE
Provider Second Line Business Practice Location Address:
WAYNE COMMONS, SUITE 101
Provider Business Practice Location Address City Name:
WAYNE
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07470-2025
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-942-6005
Provider Business Practice Location Address Fax Number:
973-942-6009
Provider Enumeration Date:
05/30/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  25MB08249300 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0152757 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: P3834330 . This is a "OXFORD#" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 3K7491 . This is a "HEALTHNET#" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0175993 . This is a "GHI PPO#" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 164231 . This is a "AETNA HMO#" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 2870423000 . This is a "AMERIHEALTH#" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 7305262 . This is a "AETNA PPO#" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 6048P1 . This is a "EMPIRE BCBS#" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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