1164408159 NPI number — MRS. SUZANN PATRICIA GRAVIUS C.R.N.A.

Table of content: MRS. SUZANN PATRICIA GRAVIUS C.R.N.A. (NPI 1164408159)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164408159 NPI number — MRS. SUZANN PATRICIA GRAVIUS C.R.N.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GRAVIUS
Provider First Name:
SUZANN
Provider Middle Name:
PATRICIA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
C.R.N.A.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MURPHY
Provider Other First Name:
SUZANN
Provider Other Middle Name:
P
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
C.R.N.A.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1164408159
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/03/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7 HENRY ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORANGEBURG
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10962-2306
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-613-7957
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
800 WESTCHESTER AVE # 511
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RYE BROOK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10573-1354
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
914-428-5354
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/21/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 367500000X , with the licence number:  477871-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com