MEDICARE: MRS. KIMBERLY Y GRAZI MSED

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	171M00000X	Case Manager/Care Coordinator		NY

General Provider Information

NPI Number	:	1548715204
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KIMBERLY Y GRAZI MSED

Provider Business Mailing Address
First Line	:	1214 AVENUE V
Second Line	:	2ND FL
City	:	BROOKLYN
State	:	NY
Zip	:	11229-4127
Country	:	US
Telephone Number	:	646-441-8140
Fax Number	:

Provider Business Practice Location Address
First Line	:	1214 AVENUE V
Second Line	:	2ND FL
City	:	BROOKLYN
State	:	NY
Zip	:	11229-4127
Country	:	US
Telephone Number	:	646-441-8140
Fax Number	:

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

Provider Enumeration Date	:	08/23/2016
Last Update Date	:	08/23/2016

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