Individual
DR. GRACE MATTHEW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
375 SEGUINE AVE, STATEN ISLAND, NY 10309-3932
(718) 226-2512
(718) 226-2098
Mailing address
1 EDGEWATER ST, SUITE 723, STATEN ISLAND, NY 10305-4900
(718) 226-1047
(718) 226-1039
Taxonomy
Speciality
Code
Description
License number
State
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
135938
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01268088
—
NY
Enumeration date
11/22/2005
Last updated
07/08/2007
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