Healthcare Provider Details

I. General information

NPI: 1467655670
Provider Name (Legal Business Name): BARRY H GRAYSON DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 1ST AVE NEW YORK UNIVERSITY MEDICAL CENTER
NEW YORK NY
10016-6402
US

IV. Provider business mailing address

560 1ST AVE NEW YORK UNIVERSITY MEDICAL CENTER
NEW YORK NY
10016-6402
US

V. Phone/Fax

Practice location:
  • Phone: 212-263-5204
  • Fax: 212-263-6002
Mailing address:
  • Phone: 212-263-5204
  • Fax: 212-263-6002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number029262-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: