Provider Demographics
NPI:1194885426
Name:GRECO, PETER ANTHONY (PHD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:ANTHONY
Last Name:GRECO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:577 WESTFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07090-3373
Mailing Address - Country:US
Mailing Address - Phone:908-232-2005
Mailing Address - Fax:909-232-2005
Practice Address - Street 1:577 WESTFIELD AVE
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07090-3373
Practice Address - Country:US
Practice Address - Phone:908-232-2005
Practice Address - Fax:909-232-2005
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI002132103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJGR668350Medicare ID - Type Unspecified