MEDICARE: GRACE JAMMAL PA-C

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	363A00000X	Physician Assistant		NY

General Provider Information

NPI Number	:	1578431128
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRACE JAMMAL PA-C

Provider Business Mailing Address
First Line	:	2405 E 7TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11223-5405
Country	:	US
Telephone Number	:	718-799-4600
Fax Number	:

Provider Business Practice Location Address
First Line	:	6201 15TH AVE STE 305
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11219-5411
Country	:	US
Telephone Number	:	718-799-4600
Fax Number	:

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

Provider Enumeration Date	:	10/27/2025
Last Update Date	:	10/27/2025

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Directions to “ GRACE JAMMAL PA-C” Practice Location

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