Healthcare Provider Details

I. General information

NPI: 1356239198
Provider Name (Legal Business Name): TAYLOR GRADER PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2025
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

718 TEANECK RD
TEANECK NJ
07666-4245
US

IV. Provider business mailing address

130 KINDERKAMACK RD STE 200
RIVER EDGE NJ
07661-1951
US

V. Phone/Fax

Practice location:
  • Phone: 201-833-3000
  • Fax:
Mailing address:
  • Phone: 201-488-2660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number25MP00946600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: