Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 143595 | NY |
NPI | 1033210661 |
---|---|
Provider Name | Martha S Grayson |
First Address | New York, NY 10001-2603 |
Second Address | New York, NY 10011-8202 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2006 |
Last Update Date | 29/03/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01009287 | (05) | NY |
E87276 | (02) |