MEDICARE: DR. NOAH SOL GRATCH MD

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	207N00000X	Dermatology Physician	229531	NY

General Provider Information

NPI Number	:	1558380816
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NOAH SOL GRATCH MD

Provider Business Mailing Address
First Line	:	820 2ND AVE
Second Line	:	3A
City	:	NEW YORK
State	:	NY
Zip	:	10017
Country	:	US
Telephone Number	:	212-661-3376
Fax Number	:	212-661-6327

Provider Business Practice Location Address
First Line	:	820 2ND AVE
Second Line	:	3A
City	:	NEW YORK
State	:	NY
Zip	:	10017-4502
Country	:	US
Telephone Number	:	212-661-3376
Fax Number	:	212-661-6327

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

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	01/28/2014

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