=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134632250
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GRAFE STREET SERVICE CORP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/10/2017
-----------------------------------------------------
Last Update Date | 06/16/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 282 AVENUE U
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11223-3944
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-343-0300
-----------------------------------------------------
Fax | 718-382-3965
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 282 AVENUE U
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11223-3944
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-343-0300
-----------------------------------------------------
Fax | 718-382-3965
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MRS. JULIA TORBIN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 212-343-0300
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 344600000X
-----------------------------------------------------
Taxonomy Name | Taxi
-----------------------------------------------------
License Number | B01970
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------