Individual
AMANDA COYNE GREGG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
255 EXECUTIVE DR STE LL105, PLAINVIEW, NY 11803-1718
(516) 576-2040
Mailing address
515 VENETIAN BLVD, LINDENHURST, NY 11757-6327
(631) 525-3718
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
1672899221
NY
Other
Enumeration date
10/24/2023
Last updated
11/26/2024
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