Healthcare Provider Details

I. General information

NPI: 1124149737
Provider Name (Legal Business Name): EMILY O'BRIEN GRAY-VOORHEES PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 03/12/2020
Certification Date: 03/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 OVERLOOK RD STE 201
SUMMIT NJ
07901-3562
US

IV. Provider business mailing address

PO BOX 416457
BOSTON MA
02241-6457
US

V. Phone/Fax

Practice location:
  • Phone: 908-795-1194
  • Fax:
Mailing address:
  • Phone: 844-362-1735
  • Fax: 973-290-7495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number25MP00051700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: