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General NPI Number Information
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NPI Number | 1386025708
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Entity Type | Individual
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Provider Name | KATIE O'GRADY
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Gender | Female
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Dates
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Enumeration Date | 06/11/2015
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Last Update Date | 09/06/2023
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Provider Practice Location Address
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Address Line | 4 BRIGHTON RD STE 208
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City | CLIFTON
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State | NJ
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Zip | 07012-1665
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Country | US
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Telephone | 201-424-2999
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Fax |
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Provider Business Mailing Address
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Address Line | 98 VALLEY RD
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City | GLEN ROCK
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State | NJ
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Zip | 07452-1723
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 25MA11287400
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License Number State | NJ
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