Healthcare Provider Details

I. General information

NPI: 1699694992
Provider Name (Legal Business Name): SELAH GRAY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

780 HARDING HWY
PILESGROVE NJ
08098-2909
US

IV. Provider business mailing address

5652 MIRIAM RD
PHILADELPHIA PA
19124-1021
US

V. Phone/Fax

Practice location:
  • Phone: 856-621-9844
  • Fax:
Mailing address:
  • Phone: 856-621-9845
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332U00000X
TaxonomyHome Delivered Meals
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: