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General NPI Number Information
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NPI Number | 1578565610
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Entity Type | Individual
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Provider Name | WILLIAM RUSSELL GRACE M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/01/2005
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Last Update Date | 04/25/2017
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Provider Practice Location Address
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Address Line | 945 FIFTH AVENUE
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City | NEW YORK
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State | NY
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Zip | 10021-2661
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Country | US
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Telephone | 212-675-6826
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Fax | 212-366-1697
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Provider Business Mailing Address
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Address Line | 36 7TH AVE STE 511
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City | NEW YORK
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State | NY
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Zip | 10011-6600
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Country | US
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Telephone | 212-675-6826
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Fax | 212-366-1697
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 108472
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License Number State | NY
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