1477691392 NPI number — MS. GRACE STERLING L.P.C., LCADC

Table of content: MS. GRACE STERLING L.P.C., LCADC (NPI 1477691392)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477691392 NPI number — MS. GRACE STERLING L.P.C., LCADC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STERLING
Provider First Name:
GRACE
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
L.P.C., LCADC
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:
1477691392
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/13/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
942 W LAKE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RAHWAY
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07065-1620
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-476-5298
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2816 MORRIS AVE
Provider Second Line Business Practice Location Address:
LOWER LEVEL
Provider Business Practice Location Address City Name:
UNION
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07083-4849
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
908-687-8088
Provider Business Practice Location Address Fax Number:
908-687-8066
Provider Enumeration Date:
02/02/2007

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: 101YA0400X , with the licence number:  37LC00092300 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X , with the licence number: 37PC00044700 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 10766216 . This is a "CAQH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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