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Individual
GRANT ELY
Active
Individual
GRANT ELY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
031910
NY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/22/2024
Last updated
04/03/2026
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