Provider Demographics
NPI:1518917129
Name:GRAY, TERENCE B (MD)
Entity Type:Individual
Prefix:
First Name:TERENCE
Middle Name:B
Last Name:GRAY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:68 S SERVICE RD
Mailing Address - Street 2:SUITE 350
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-2354
Mailing Address - Country:US
Mailing Address - Phone:516-945-3000
Mailing Address - Fax:516-945-3131
Practice Address - Street 1:121 DEKALB AVE
Practice Address - Street 2:DEPT OF ANESTHESIA
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-5425
Practice Address - Country:US
Practice Address - Phone:718-250-8259
Practice Address - Fax:516-945-3131
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2013-02-21
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Provider Licenses
StateLicense IDTaxonomies
NY254233207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G574500Medicaid
NY03186156Medicaid
NYG400077264Medicare PIN
CA00G574500Medicaid
NY03186156Medicaid
00G574500Medicare ID - Type Unspecified