Provider Demographics
NPI:1073739074
Name:GRADY, KATHLEEN M (ANP)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:M
Last Name:GRADY
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3003 NEW HYDE PARK ROAD
Mailing Address - Street 2:SUITE 411
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11042
Mailing Address - Country:US
Mailing Address - Phone:516-327-0001
Mailing Address - Fax:516-326-9753
Practice Address - Street 1:3003 NEW HYDE PARK ROAD
Practice Address - Street 2:SUITE 411
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042
Practice Address - Country:US
Practice Address - Phone:516-327-0001
Practice Address - Fax:516-326-9753
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF303134363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health