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Organization
THREE GRACES MEDICAL PRACTICE PLLC
Active
Organization
THREE GRACES MEDICAL PRACTICE PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MYRA WHITE M.D. (PRESIDENT)
(718) 933-0333
Entity
Organization
Contact information
Practice address
550 E 180TH ST, BRONX, NY 10457-3304
(718) 933-0333
(718) 933-0337
Mailing address
550 E 180TH ST, BRONX, NY 10457-3304
(718) 933-0333
(718) 933-0337
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
176524
NY
207Q00000X
Family Medicine Physician
Primary
176524
NY
207R00000X
Internal Medicine Physician
176524
NY
208000000X
Pediatrics Physician
176524
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01512445
—
NY
Enumeration date
09/01/2011
Last updated
09/12/2011
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