Provider Demographics
NPI:1346649902
Name:BYGRAVE, MARCIA
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:
Last Name:BYGRAVE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4543 CARPENTER AVE
Mailing Address - Street 2:APT 1F
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10470-1425
Mailing Address - Country:US
Mailing Address - Phone:646-316-9330
Mailing Address - Fax:
Practice Address - Street 1:4543 CARPENTER AVE
Practice Address - Street 2:APT 1F
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10470-1425
Practice Address - Country:US
Practice Address - Phone:646-316-9330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-20
Last Update Date:2014-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator