Healthcare Provider Details

I. General information

NPI: 1932933157
Provider Name (Legal Business Name): MRS. MONIQUE B GRAY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2024
Last Update Date: 08/29/2024
Certification Date: 08/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 WATER ST STE 401
WHITE PLAINS NY
10601-1401
US

IV. Provider business mailing address

29 LOIS LN
MONROE NY
10950-4164
US

V. Phone/Fax

Practice location:
  • Phone: 914-216-7585
  • Fax:
Mailing address:
  • Phone: 845-987-4713
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License Number648146-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: