Provider Demographics
NPI:1518013184
Name:GRAF, JEANNETTE O (MD)
Entity Type:Individual
Prefix:DR
First Name:JEANNETTE
Middle Name:O
Last Name:GRAF
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 1:88 BAYVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-1032
Mailing Address - Country:US
Mailing Address - Phone:516-466-0005
Mailing Address - Fax:516-466-5722
Practice Address - Street 1:88 BAYVIEW AVE
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-1032
Practice Address - Country:US
Practice Address - Phone:516-466-0005
Practice Address - Fax:516-466-5722
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY162176174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY45F482Medicare ID - Type Unspecified
NYE45066Medicare UPIN