Healthcare Provider Details

I. General information

NPI: 1508438201
Provider Name (Legal Business Name): TAYLOR ROSE GRIFFIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2021
Last Update Date: 07/13/2021
Certification Date: 07/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 CHICAGO AVE
STATEN ISLAND NY
10305-3757
US

IV. Provider business mailing address

40 ROCKVILLE AVE
STATEN ISLAND NY
10314-3720
US

V. Phone/Fax

Practice location:
  • Phone: 718-442-7828
  • Fax:
Mailing address:
  • Phone: 347-902-3804
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number110702-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: