Healthcare Provider Details

I. General information

NPI: 1619635323
Provider Name (Legal Business Name): GRAE ENTERPRISES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2021
Last Update Date: 11/30/2021
Certification Date: 11/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

89 5TH AVE STE 808
NEW YORK NY
10003-3020
US

IV. Provider business mailing address

89 5TH AVE STE 808
NEW YORK NY
10003-3020
US

V. Phone/Fax

Practice location:
  • Phone: 347-728-2440
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code132700000X
TaxonomyDietary Manager
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. TIMOTHY GRAE
Title or Position: MASSAGE THERAPIST
Credential:
Phone: 347-728-2440