Provider Demographics
NPI:1013118660
Name:GREGG, JOHN ANTHONY (DO)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ANTHONY
Last Name:GREGG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:510 HAMBURG TPKE
Mailing Address - Street 2:WAYNE COMMONS, SUITE 101
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-2025
Mailing Address - Country:US
Mailing Address - Phone:973-942-6005
Mailing Address - Fax:973-942-6009
Practice Address - Street 1:510 HAMBURG TPKE
Practice Address - Street 2:WAYNE COMMONS, SUITE 101
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-2025
Practice Address - Country:US
Practice Address - Phone:973-942-6005
Practice Address - Fax:973-942-6009
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MB08249300207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0152757Medicaid
NJP3834330OtherOXFORD#
NJ3K7491OtherHEALTHNET#
NJ0175993OtherGHI PPO#
NJ164231OtherAETNA HMO#
NJ2870423000OtherAMERIHEALTH#
NJ7305262OtherAETNA PPO#
NJ6048P1OtherEMPIRE BCBS#
NJ2870423000OtherAMERIHEALTH#