Healthcare Provider Details

I. General information

NPI: 1174517312
Provider Name (Legal Business Name): JEROLD BRUCE GRAFF MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2005
Last Update Date: 01/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 E GROVE ST
WESTFIELD NJ
07090-1687
US

IV. Provider business mailing address

240 E GROVE ST
WESTFIELD NJ
07090-1687
US

V. Phone/Fax

Practice location:
  • Phone: 908-232-6446
  • Fax: 908-232-6447
Mailing address:
  • Phone: 908-232-6446
  • Fax: 908-232-6447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number25MA02446000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: