Provider Demographics
NPI:1518227578
Name:GRAY, JADE MARIE (DPM)
Entity Type:Individual
Prefix:
First Name:JADE
Middle Name:MARIE
Last Name:GRAY
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:JADE
Other - Middle Name:MARIE
Other - Last Name:BARNARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPM
Mailing Address - Street 1:3046 KNIGHTS RD
Mailing Address - Street 2:
Mailing Address - City:BENSALEM
Mailing Address - State:PA
Mailing Address - Zip Code:19020-2815
Mailing Address - Country:US
Mailing Address - Phone:215-639-4500
Mailing Address - Fax:215-604-0355
Practice Address - Street 1:1725 KLOCKNER RD
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08619-2711
Practice Address - Country:US
Practice Address - Phone:609-586-6700
Practice Address - Fax:609-586-8768
Is Sole Proprietor?:No
Enumeration Date:2012-05-24
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00313200213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist