1750583290 NPI number — MS. SONIA E GRAY DDS

Table of content: MS. SONIA E GRAY DDS (NPI 1750583290)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750583290 NPI number — MS. SONIA E GRAY DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GRAY
Provider First Name:
SONIA
Provider Middle Name:
E
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
DDS
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:
1750583290
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/23/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
30 E 33RD ST
Provider Second Line Business Mailing Address:
FAMILY PAVILION
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10016-5337
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-366-4459
Provider Business Mailing Address Fax Number:
212-366-1773

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
199 ATKINS AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11208
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-235-9132
Provider Business Practice Location Address Fax Number:
718-235-9133
Provider Enumeration Date:
06/05/2007

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: 1223G0001X , with the licence number:  0438191 , 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)

  • Identifier: 01282484 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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