Provider Demographics
NPI:1477634350
Name:GRAY, MICHAEL T (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:T
Last Name:GRAY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:125 SUNRISE HWY
Mailing Address - Street 2:
Mailing Address - City:WEST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11795-2023
Mailing Address - Country:US
Mailing Address - Phone:631-376-6075
Mailing Address - Fax:631-376-6091
Practice Address - Street 1:40 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-8301
Practice Address - Country:US
Practice Address - Phone:631-376-6075
Practice Address - Fax:631-376-6091
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2024-04-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY201426174400000X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY92557YXRV1Medicare PIN
NYG5839Medicare UPIN