Individual
ALLA S GRAYFER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
29 ELMTREE AVE, STATEN ISLAND, NY 10306-5055
(917) 208-0698
Mailing address
29 ELMTREE AVE, STATEN ISLAND, NY 10306-5055
(917) 208-0698
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
368679031
17 OTHER SERVICE PROVIDERS
NY
01
—
620083674
DRIVER LICENCE
NY
Enumeration date
10/29/2019
Last updated
10/29/2019
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