Provider Demographics
NPI:1548373384
Name:CORAM, GREGORY JOSEPH (PSYD & APN-BC)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:JOSEPH
Last Name:CORAM
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Gender:M
Credentials:PSYD & APN-BC
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Mailing Address - Street 1:115 GRAYSON DR
Mailing Address - Street 2:
Mailing Address - City:BELLE MEAD
Mailing Address - State:NJ
Mailing Address - Zip Code:08502-4932
Mailing Address - Country:US
Mailing Address - Phone:908-581-7403
Mailing Address - Fax:908-281-4443
Practice Address - Street 1:40 BEY LEA RD
Practice Address - Street 2:SUITE B 201
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-2900
Practice Address - Country:US
Practice Address - Phone:732-240-5544
Practice Address - Fax:732-240-1180
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2024-09-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJ35S100236700103TC0700X
NJ26NJ00061900363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical