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General NPI Number Information
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NPI Number | 1932116530
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Entity Type | Individual
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Provider Name | JAY GRAHAM M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/03/2006
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Last Update Date | 09/30/2025
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Provider Practice Location Address
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Address Line | 140 BERGEN ST
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City | NEWARK
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State | NJ
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Zip | 07103-2425
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Country | US
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Telephone | 646-832-0904
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Fax |
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Provider Business Mailing Address
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Address Line | 140 BERGEN ST
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City | NEWARK
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State | NJ
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Zip | 07103-2425
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Country | US
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Telephone | 646-832-0904
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 228086
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 25MA12788700
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 265290
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License Number State | NY
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Taxonomy #4
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Taxonomy Code | 204F00000X
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Taxonomy Name | Transplant Surgery Physician
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License Number | 25MA12788700
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License Number State | NJ
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