Individual
DR. GREGORY SUPRIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
8810 PARSONS BLVD, JAMAICA, NY 11432-3842
(718) 291-8111
(718) 487-9343
Mailing address
111 BROADWAY, #1005, NEW YORK, NY 10006-1951
(646) 217-4610
(917) 591-8596
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
230165
NY
207Q00000X
Family Medicine Physician
230165-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02585106
—
NY
Enumeration date
05/28/2006
Last updated
06/04/2014
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