=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386961795
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MICHAEL R. GRAY MD PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/24/2010
-----------------------------------------------------
Last Update Date | 04/24/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 51 E 42ND ST SUITE 707
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10017-5404
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-684-5477
-----------------------------------------------------
Fax | 212-684-3507
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 51 E 42ND ST SUITE 707
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10017-5404
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-684-5477
-----------------------------------------------------
Fax | 212-684-3507
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. MICHAEL ROBERT GRAY
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 212-684-5477
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number | 166679
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------