Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 008766-1 | NY |
NPI | 1033670609 |
---|---|
Provider Name | Christopher M Gray |
First Address | Ozone Park, NY 11417-3004 |
Second Address | Ozone Park, NY 11417-3004 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2019 |
Last Update Date | 27/03/2019 |