1083623177 NPI number — TIMOTHY RICHARD GREGORY LCSW

Table of content: TIMOTHY RICHARD GREGORY LCSW (NPI 1083623177)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083623177 NPI number — TIMOTHY RICHARD GREGORY LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GREGORY
Provider First Name:
TIMOTHY
Provider Middle Name:
RICHARD
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW
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:
1083623177
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3159
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORT JERVIS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12771-0257
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
56 FRONT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORT JERVIS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12771-2415
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-858-3253
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/07/2006

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: 1041C0700X , with the licence number:  R043053 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 475049000 . This is a "MAGELLEN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1032020 . This is a "AFFINITY HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: N63253 . This is a "EMPIRE BLUE CROSS/SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: N63253 . This is a "BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: YS112 . This is a "OXFORD HEALTH PLANS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 164055 . This is a "VALUEOPTIONS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1032020 . This is a "HUDSON HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1032020 . This is a "BEACON HEALTH STRATEGIES" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7406375003 . This is a "GHI" identifier . This identifiers is of the category "OTHER".
  • Identifier: N63252 . This is a "EMPIRE BLUE CROSS/SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0007782292 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: N63252 . This is a "BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".




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