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General NPI Number Information
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NPI Number | 1902674427
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Entity Type | Individual
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Provider Name | JOSEPH GRAYBILL
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Gender | Male
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Dates
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Enumeration Date | 12/14/2023
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Last Update Date | 12/14/2023
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Provider Practice Location Address
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Address Line | 6 W LAWRENCE PARK DR UNIT 2
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City | PIERMONT
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State | NY
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Zip | 10968-3125
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Country | US
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Telephone | 201-247-8926
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Fax |
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Provider Business Mailing Address
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Address Line | 78 ACKERMAN AVE
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City | EMERSON
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State | NJ
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Zip | 07630-1758
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 019579-01
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License Number State | NY
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