| Doctor Name: | DR. GLENN GREY |
| NPI Number: | 1558368472 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD |
| License Number: | MA68163 |
| Business Practice Address: | 703 Main St Paterson, NJ - 075032621 |
| Business Phone Number: | 9737542790 |
| Business Fax Number: | 9737542791 |
| Mailing Address: | 3998 Fair Ridge Rd, Suite 300 FAIRFAX |
| State: | VA |
| Postal Code: | 220332921 |
| Phone Number: | 7032959360 |
| Fax Number: | 7037669725 |
| NPI Enumeration Date: | 07/07/2005 |
| NPI Last Update Date: | 03/20/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 174400000X |
| License Number: | MA68163 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NJ |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Specialist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |