Healthcare Provider Details

I. General information

NPI: 1336255215
Provider Name (Legal Business Name): MR. LANCE JAMES GRAU
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 06/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4400 BISCAYNE BLVD
MIAMI FL
33137
US

IV. Provider business mailing address

PO BOX 453
ELMWOOD PARK NJ
07407-0453
US

V. Phone/Fax

Practice location:
  • Phone: 833-436-3832
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: