Provider Demographics
NPI:1871561076
Name:GRECO, MICHELE M (MD)
Entity type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:M
Last Name:GRECO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:MICHELE
Other - Middle Name:M
Other - Last Name:MAHN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:185 RYKOWSKI LN.
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10941-4019
Mailing Address - Country:US
Mailing Address - Phone:845-692-0030
Mailing Address - Fax:845-692-0037
Practice Address - Street 1:707 E MAIN ST
Practice Address - Street 2:RADIOLOGIC ASSOCIATES, PC
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940-2650
Practice Address - Country:US
Practice Address - Phone:845-333-1258
Practice Address - Fax:845-343-0617
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2053772085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY300108321OtherRAILROAD MEDICARE
NY300108324OtherRAILROAD MEDICARE
NY300108319OtherRAILROAD MEDICARE
NY300108327OtherRAILROAD MEDICARE
NY300108318OtherRAILROAD MEDICARE
NY300108323OtherRAILROAD MEDICARE
NY300108325OtherRAILROAD MEDICARE
NY01905820Medicaid
NY300108328OtherRAILROAD MEDICARE
NY300108320OtherRAILROAD MEDICARE
NY300108326OtherRAILROAD MEDICARE
NY300108325OtherRAILROAD MEDICARE
NY01905820Medicaid