Provider Demographics
NPI:1013212950
Name:GRAY, BRETT (ANP, MPH)
Entity Type:Individual
Prefix:MR
First Name:BRETT
Middle Name:
Last Name:GRAY
Suffix:
Gender:M
Credentials:ANP, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 WEST 168TH STREET
Mailing Address - Street 2:BOX 4
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-3725
Mailing Address - Country:US
Mailing Address - Phone:212-305-1570
Mailing Address - Fax:212-305-2885
Practice Address - Street 1:180 FORT WASHINGTON AVE
Practice Address - Street 2:HP2
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-3722
Practice Address - Country:US
Practice Address - Phone:212-305-1570
Practice Address - Fax:212-305-2885
Is Sole Proprietor?:No
Enumeration Date:2011-01-25
Last Update Date:2017-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY305609363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health