MEDICARE: GENENE GRAY-BERCY

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	407947	NY
2	163W00000X	Registered Nurse	713635	NY

General Provider Information

NPI Number	:	1861849606
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GENENE GRAY-BERCY

Provider Business Mailing Address
First Line	:	11944 194TH ST
Second Line	:
City	:	SAINT ALBANS
State	:	NY
Zip	:	11412-3712
Country	:	US
Telephone Number	:	917-421-0091
Fax Number	:

Provider Business Practice Location Address
First Line	:	11944 194TH ST
Second Line	:
City	:	SAINT ALBANS
State	:	NY
Zip	:	11412-3712
Country	:	US
Telephone Number	:	917-421-0091
Fax Number	:

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

Provider Enumeration Date	:	05/23/2016
Last Update Date	:	02/04/2026

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Directions to “ GENENE GRAY-BERCY ” Practice Location

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