MEDICARE: MS. GAIL DIANE GRANAT MS. EDUCATION

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	171W00000X	Contractor	158403071	NY

General Provider Information

NPI Number	:	1093960379
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. GAIL DIANE GRANAT MS. EDUCATION

Provider Business Mailing Address
First Line	:	6945 108TH ST APT 6F
Second Line	:
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-3836
Country	:	US
Telephone Number	:	718-520-8267
Fax Number	:

Provider Business Practice Location Address
First Line	:	6945 108TH ST APT 6F
Second Line	:
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-3836
Country	:	US
Telephone Number	:	718-520-8267
Fax Number	:

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

Provider Enumeration Date	:	11/30/2008
Last Update Date	:	11/30/2008

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