Healthcare Provider Details

I. General information

NPI: 1932329489
Provider Name (Legal Business Name): GRACE KUO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2231 LEMOINE AVE
FORT LEE NJ
07024-6115
US

IV. Provider business mailing address

2231 LEMOINE AVE
FORT LEE NJ
07024-6115
US

V. Phone/Fax

Practice location:
  • Phone: 201-944-1008
  • Fax: 201-242-0029
Mailing address:
  • Phone: 201-944-1008
  • Fax: 201-242-0029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MA07997400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: