Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 305609 | NY |
NPI | 1013212950 |
---|---|
Provider Name | Mr. Brett Gray |
First Address | New York, NY 10032-3725 |
Second Address | New York, NY 10032-3722 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/01/2011 |
Last Update Date | 31/05/2017 |