1447280581 NPI number — BRIAN L. FAST, PSY.D. AND STEPHEN P. GREGGO, PSY.D, PSYCHOLOGISTS, P.C

Table of content: (NPI 1447280581)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447280581 NPI number — BRIAN L. FAST, PSY.D. AND STEPHEN P. GREGGO, PSY.D, PSYCHOLOGISTS, P.C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BRIAN L. FAST, PSY.D. AND STEPHEN P. GREGGO, PSY.D, PSYCHOLOGISTS, P.C
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1447280581
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/10/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
29 JAY UNIT 1067
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SCHENECTADY
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12301-3307
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-374-7555
Provider Business Mailing Address Fax Number:
518-374-6898

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
196 DELAWARE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DELMAR
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12054-1227
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-439-0033
Provider Business Practice Location Address Fax Number:
518-439-7167
Provider Enumeration Date:
07/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KOONZ
Authorized Official First Name:
JILL
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
518-439-0033

Provider Taxonomy Codes

  • Taxonomy code: 103TC1900X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 01727095 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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