Healthcare Provider Details

I. General information

NPI: 1225945983
Provider Name (Legal Business Name): MS. GRACIA NIBIGIRA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 S MAPLE AVE APT A1
RIDGEWOOD NJ
07450-4533
US

IV. Provider business mailing address

160 S MAPLE AVE APT A1
RIDGEWOOD NJ
07450-4533
US

V. Phone/Fax

Practice location:
  • Phone: 518-526-6453
  • Fax:
Mailing address:
  • Phone: 518-526-6453
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number44SL07522300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: