1982123717 NPI number — MRS. VICTORIA ELIZABETH GRAY FNP

Table of content: MRS. VICTORIA ELIZABETH GRAY FNP (NPI 1982123717)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982123717 NPI number — MRS. VICTORIA ELIZABETH GRAY FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GRAY
Provider First Name:
VICTORIA
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
FNP
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:
1982123717
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/17/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 COMMUNITY DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MANHASSET
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11030-3816
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-562-4290
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19448 111TH RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAINT ALBANS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11412-2019
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
917-573-3619
Provider Business Practice Location Address Fax Number:
929-333-9664
Provider Enumeration Date:
09/13/2017

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: 363LF0000X , with the licence number:  340876 , 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)





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