Provider Demographics
NPI:1538231717
Name:GRECO, GINA C (DO)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:C
Last Name:GRECO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2840 JERUSALEM AVE
Mailing Address - Street 2:
Mailing Address - City:WANTAGH
Mailing Address - State:NY
Mailing Address - Zip Code:11793-2017
Mailing Address - Country:US
Mailing Address - Phone:516-781-1141
Mailing Address - Fax:516-781-1184
Practice Address - Street 1:2840 JERUSALEM AVE
Practice Address - Street 2:
Practice Address - City:WANTAGH
Practice Address - State:NY
Practice Address - Zip Code:11793-2017
Practice Address - Country:US
Practice Address - Phone:516-781-1141
Practice Address - Fax:516-781-1184
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY188216207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY59H828G791Medicare PIN
F55063Medicare UPIN