Provider Demographics
NPI:1033210661
Name:GRAYSON, MARTHA S (MD)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:S
Last Name:GRAYSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 W 33RD ST
Mailing Address - Street 2:PBS 12TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-2603
Mailing Address - Country:US
Mailing Address - Phone:212-356-4474
Mailing Address - Fax:212-356-4608
Practice Address - Street 1:170 W 12TH ST
Practice Address - Street 2:MEDICINE/ GENERAL
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-8202
Practice Address - Country:US
Practice Address - Phone:212-356-4474
Practice Address - Fax:212-356-4608
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY143595208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01009287Medicaid
32F08Medicare ID - Type Unspecified
NY01009287Medicaid