Provider Demographics
NPI:1902977549
Name:GREMLI, VICTOR C JR (DC)
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:C
Last Name:GREMLI
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 CARLETON AVE
Mailing Address - Street 2:SUITE #6
Mailing Address - City:EAST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11730-2133
Mailing Address - Country:US
Mailing Address - Phone:631-277-7788
Mailing Address - Fax:631-277-7789
Practice Address - Street 1:55 CARLETON AVE
Practice Address - Street 2:SUITE #6
Practice Address - City:EAST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11730-2133
Practice Address - Country:US
Practice Address - Phone:631-277-7788
Practice Address - Fax:631-277-7789
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2010-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003916111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX21131Medicare PIN