Healthcare Provider Details

I. General information

NPI: 1093981425
Provider Name (Legal Business Name): GRACE E. FARRIS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2008
Last Update Date: 04/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 AMSTERDAM AVE CLARK 7
NEW YORK NY
10025-1716
US

IV. Provider business mailing address

1111 AMSTERDAM AVE CLARK 7
NEW YORK NY
10025-1716
US

V. Phone/Fax

Practice location:
  • Phone: 212-523-5918
  • Fax: 212-523-2842
Mailing address:
  • Phone: 212-523-5918
  • Fax: 212-523-2842

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number286724
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number249078
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: