=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306613997
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GRACE MODERN HEALTH, P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/05/2023
-----------------------------------------------------
Last Update Date | 02/02/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 34 GREEN ST
-----------------------------------------------------
City | WOODBRIDGE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07095-3353
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-930-0052
-----------------------------------------------------
Fax | 908-565-1529
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 34 GREEN ST UNIT C-1
-----------------------------------------------------
City | WOODBRIDGE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07095-3353
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-930-0052
-----------------------------------------------------
Fax | 908-565-1529
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | GRACE CABANILLAS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 732-407-6130
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------