Provider Demographics
NPI:1689102055
Name:GREICO, MICHAEL V JR (PA)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:V
Last Name:GREICO
Suffix:JR
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 N 10TH ST
Mailing Address - Street 2:
Mailing Address - City:MILLVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08332-2042
Mailing Address - Country:US
Mailing Address - Phone:856-327-6446
Mailing Address - Fax:856-327-0158
Practice Address - Street 1:1700 N 10TH ST
Practice Address - Street 2:
Practice Address - City:MILLVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08332-2042
Practice Address - Country:US
Practice Address - Phone:856-327-6446
Practice Address - Fax:856-327-0158
Is Sole Proprietor?:No
Enumeration Date:2017-05-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MP00424800363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical