Provider Demographics
NPI:1093960379
Name:GRANAT, GAIL DIANE (MS EDUCATION)
Entity Type:Individual
Prefix:MS
First Name:GAIL
Middle Name:DIANE
Last Name:GRANAT
Suffix:
Gender:F
Credentials:MS EDUCATION
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6945 108TH ST APT 6F
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-3836
Mailing Address - Country:US
Mailing Address - Phone:718-520-8267
Mailing Address - Fax:
Practice Address - Street 1:6945 108TH ST APT 6F
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-3836
Practice Address - Country:US
Practice Address - Phone:718-520-8267
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-30
Last Update Date:2008-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY158403071171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor