Provider Demographics
NPI:1609410067
Name:GRAYFER, ALLA S
Entity Type:Individual
Prefix:
First Name:ALLA
Middle Name:S
Last Name:GRAYFER
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 1:29 ELMTREE AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-5055
Mailing Address - Country:US
Mailing Address - Phone:917-208-0698
Mailing Address - Fax:
Practice Address - Street 1:29 ELMTREE AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306-5055
Practice Address - Country:US
Practice Address - Phone:917-208-0698
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-29
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY620083674OtherDRIVER LICENCE
NY368679031Other17 OTHER SERVICE PROVIDERS