Gregg Fader DMD, PC

Primary specialty

DentistTaxonomy code 122300000X

License

040972 Issued in NY

Legal business name

GREGG FADER DMD, PC

Practice address

504 Grand St
Suite M5
New York, NY 10002-4182

Phone

(212) 475-0051

Fax

(212) 475-3279

NPI assigned

Apr 8, 2014

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Gregg Fader, DMD

Title

Owner

Phone

(212) 475-0051

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1396915200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1396915200000",
    "number": "1831518786",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "504 GRAND ST",
            "address_2": "SUITE M5",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100024182",
            "telephone_number": "212-475-0051",
            "fax_number": "212-475-3279"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "504 GRAND ST",
            "address_2": "SUITE M5",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100024182",
            "telephone_number": "212-475-0051",
            "fax_number": "212-475-3279"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREGG FADER DMD, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-04-08",
        "last_updated": "2014-04-08",
        "status": "A",
        "authorized_official_last_name": "FADER",
        "authorized_official_first_name": "GREGG",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "212-475-0051",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "NY",
            "license": "040972",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01259301",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Greg R. Diamond D.D.S., P.C.
• Catherine Grega, PSY.D.
• Megan Greger, PA-C
• Beau Anthony Gregersen, D.C
• Celestine Gregerson, MD
• Alessandra Marie Gregg, MD
• Alexander Christopher Gregg, MD
• Bryce Wyndham Gregg, RN
• Isabel Amanda Gregg, N.P.
• Stacy Gregg

• Dentist in New York, NY
• Providers in New York, NY by specialty
• Dentist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.