Provider Demographics
NPI:1003323155
Name:GRACE MEDICAL GROUP LLC
Entity Type:Organization
Organization Name:GRACE MEDICAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AKINLABI
Authorized Official - Middle Name:ADETAYO
Authorized Official - Last Name:SANUSI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-596-1088
Mailing Address - Street 1:1600 SAINT GEORGES AVE STE 118
Mailing Address - Street 2:
Mailing Address - City:RAHWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:07065-2713
Mailing Address - Country:US
Mailing Address - Phone:732-596-1088
Mailing Address - Fax:
Practice Address - Street 1:1600 SAINT GEORGES AVE STE 118
Practice Address - Street 2:
Practice Address - City:RAHWAY
Practice Address - State:NJ
Practice Address - Zip Code:07065-2713
Practice Address - Country:US
Practice Address - Phone:732-596-1088
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-10
Last Update Date:2018-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty