Healthcare Provider Details

I. General information

NPI: 1649243684
Provider Name (Legal Business Name): MICHAEL A GRAFF M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2006
Last Update Date: 11/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 DAVIS AVE FL 7
NEPTUNE NJ
07753-4488
US

IV. Provider business mailing address

19 DAVIS AVE FL 7
NEPTUNE NJ
07753-4488
US

V. Phone/Fax

Practice location:
  • Phone: 732-776-4524
  • Fax: 732-776-4639
Mailing address:
  • Phone: 732-776-4524
  • Fax: 732-776-4639

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberMD070806L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number136169
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number25MA04393300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: