Healthcare Provider Details

I. General information

NPI: 1790219152
Provider Name (Legal Business Name): VERONICA GRAIL M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2017
Last Update Date: 01/14/2025
Certification Date: 01/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 MANHATTANVILLE RD STE 203
PURCHASE NY
10577-2118
US

IV. Provider business mailing address

791 CRANDON BLVD APT 1105
KEY BISCAYNE FL
33149-2203
US

V. Phone/Fax

Practice location:
  • Phone: 800-835-2362
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberME142604
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: