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General NPI Number Information
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NPI Number | 1659782472
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Entity Type | Individual
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Provider Name | GREYSON MCCONNELL
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Gender | Male
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Dates
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Enumeration Date | 05/14/2014
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Last Update Date | 05/14/2014
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Provider Practice Location Address
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Address Line | 127 MAIN ST STE B
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City | MEDFORD
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State | MA
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Zip | 02155-4522
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Country | US
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Telephone | 781-874-2413
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Fax |
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Provider Business Mailing Address
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Address Line | 21 OLD FORT RD
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City | BERNARDSVILLE
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State | NJ
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Zip | 07924-1810
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Country | US
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Telephone | 908-307-0006
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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 | 237700000X
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Taxonomy Name | Hearing Instrument Specialist
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License Number | #243
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License Number State | MA
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