MEDICARE: JAN ALEXANDRA GRAYSON PSY.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	4468	NJ

General Provider Information

NPI Number	:	1083851265
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAN ALEXANDRA GRAYSON PSY.D.

Provider Business Mailing Address
First Line	:	697 VALLEY ST.
Second Line	:
City	:	MAPLEWOOD
State	:	NJ
Zip	:	07040-2641
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	697 VALLEY ST
Second Line	:
City	:	MAPLEWOOD
State	:	NJ
Zip	:	07040-2641
Country	:	US
Telephone Number	:	732-735-1497
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/09/2009
Last Update Date	:	01/12/2009

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