Basic Information
| Provider Information | |||||||||
| NPI: | 1144314022 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GRECH | ||||||||
| FirstName: | DENNIS | ||||||||
| MiddleName: | GEORGE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 18914 | ||||||||
| Address2: | |||||||||
| City: | NEWARK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 071918914 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2014880066 | ||||||||
| FaxNumber: | 2014886769 | ||||||||
| Practice Location | |||||||||
| Address1: | 30 PROSPECT AVE | ||||||||
| Address2: | |||||||||
| City: | HACKENSACK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 076011914 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2014880066 | ||||||||
| FaxNumber: | 2014886769 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2006 | ||||||||
| LastUpdateDate: | 10/13/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/13/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 25MA08151600 | NJ | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 0114286 | 05 | NJ | MEDICAID | P00376802 | 01 | NJ | RAILROAD MEDICARE | OTHER | 02823710 | 05 | NY | MEDICAID |