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NPI Code Detail

MEDICARE: DR. JUAN B GRAU M.D.

MEDICARE: DR. JUAN B GRAU M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208G00000XThoracic Surgery (Cardiothoracic Vascular Surgery) Physician25MA07752800NJ
2208G00000XThoracic Surgery (Cardiothoracic Vascular Surgery) Physician231059NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1992797542
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JUAN B GRAU M.D.
Provider Business Mailing Address
First Line : 223 N VAN DIEN AVE
Second Line :
City : RIDGEWOOD
State : NJ
Zip : 07450-2726
Country : US
Telephone Number : 201-447-8371
Fax Number : 201-447-8658
Provider Business Practice Location Address
First Line : 223 N VAN DIEN AVE
Second Line :
City : RIDGEWOOD
State : NJ
Zip : 07450-2726
Country : US
Telephone Number : 201-447-8371
Fax Number : 201-447-8658
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/19/2005
Last Update Date : 02/15/2011

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