Provider Demographics
NPI:1063738797
Name:PROCOPIO, GREGORY 'GREG' (NP)
Entity type:Individual
Prefix:MR
First Name:GREGORY 'GREG'
Middle Name:
Last Name:PROCOPIO
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3841
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13220-3841
Mailing Address - Country:US
Mailing Address - Phone:315-706-5272
Mailing Address - Fax:
Practice Address - Street 1:308 CHARLANE PARKWAY
Practice Address - Street 2:
Practice Address - City:NORTH SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13212
Practice Address - Country:US
Practice Address - Phone:315-706-5272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-20
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY596534163WE0003X
NY3366365363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WE0003XNursing Service ProvidersRegistered NurseEmergency