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NPI Code Detail

MEDICARE: MS. MARY GRAY NP

MEDICARE: MS. MARY GRAY NP
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
1101YM0800XMental Health CounselorF400414NY

General Provider Information

NPI Number : 1710064217
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. MARY GRAY NP
Provider Business Mailing Address
First Line : 16 SHADOW LN
Second Line :
City : MONTVALE
State : NJ
Zip : 07645-1345
Country : US
Telephone Number : 201-476-0939
Fax Number : 201-476-0911
Provider Business Practice Location Address
First Line : 4401 BRONX BLVD
Second Line :
City : BRONX
State : NY
Zip : 10470-1407
Country : US
Telephone Number : 718-304-7080
Fax Number : 718-920-9217
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/01/2006
Last Update Date : 07/08/2007

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