1306157326 NPI number — MS. CHELSEY MICHELE GRAY P.A.

Table of content: MS. CHELSEY MICHELE GRAY P.A. (NPI 1306157326)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306157326 NPI number — MS. CHELSEY MICHELE GRAY P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GRAY
Provider First Name:
CHELSEY
Provider Middle Name:
MICHELE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
P.A.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1306157326
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/21/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
95 E CHAUTAUQUA ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MAYVILLE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14757-1017
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-753-7107
Provider Business Mailing Address Fax Number:
716-753-5367

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17 SHERMAN ST
Provider Second Line Business Practice Location Address:
SUITE 2100
Provider Business Practice Location Address City Name:
JAMESTOWN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14701-7080
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-483-6700
Provider Business Practice Location Address Fax Number:
716-664-7275
Provider Enumeration Date:
06/24/2010

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: 363AM0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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