Provider Demographics
NPI:1548288392
Name:SOLOMON, GREGORY W (MD)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:W
Last Name:SOLOMON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:899 LEXINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-6103
Mailing Address - Country:US
Mailing Address - Phone:212-717-9205
Mailing Address - Fax:404-698-2599
Practice Address - Street 1:899 LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-6103
Practice Address - Country:US
Practice Address - Phone:212-717-9205
Practice Address - Fax:404-698-2599
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY190979207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY190979OtherSTATE LICENSE
2505520OtherGHI NUMBER
190162POtherHIP HEALTH PLAN NUMBER
134032742OtherTAX ID
NY78J741OtherMEDICARE
NY01601490Medicaid
P00197966OtherRAILROAD MEDICARE NUMBER
P1115588OtherOXFORD HEALTH PLANS
P1115588OtherOXFORD HEALTH PLANS
134032742OtherTAX ID