Provider Demographics
NPI:1629407218
Name:GRANT, ELIZABETH MARY (SAS, SDA, MS MA EDD)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:MARY
Last Name:GRANT
Suffix:
Gender:F
Credentials:SAS, SDA, MS MA EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25-44 82ND ST
Mailing Address - Street 2:
Mailing Address - City:EAST ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11370
Mailing Address - Country:US
Mailing Address - Phone:718-812-1910
Mailing Address - Fax:
Practice Address - Street 1:25-44 82ND ST
Practice Address - Street 2:
Practice Address - City:EAST ELHURST
Practice Address - State:NY
Practice Address - Zip Code:11370
Practice Address - Country:US
Practice Address - Phone:718-812-1910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor