Provider Demographics
NPI:1902174394
Name:GREGORY J. MENIO, MD PC
Entity Type:Organization
Organization Name:GREGORY J. MENIO, MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:MENIO
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:570-476-2101
Mailing Address - Street 1:300 E BROWN ST
Mailing Address - Street 2:
Mailing Address - City:EAST STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18301-3012
Mailing Address - Country:US
Mailing Address - Phone:570-476-2101
Mailing Address - Fax:570-476-5646
Practice Address - Street 1:300 E BROWN ST
Practice Address - Street 2:
Practice Address - City:EAST STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301-3012
Practice Address - Country:US
Practice Address - Phone:570-476-2101
Practice Address - Fax:570-476-5646
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-13
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD036469E207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA605014OtherMEDICARE ID - TYPE UNSPECIFIED
PA605014OtherMEDICARE ID - TYPE UNSPECIFIED