Provider Demographics
NPI:1679930762
Name:GRANT, CHRISTOPHER (MSED)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:
Last Name:GRANT
Suffix:
Gender:M
Credentials:MSED
Other - Prefix:
Other - First Name:CHRISTOPHER
Other - Middle Name:
Other - Last Name:GRANT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSED
Mailing Address - Street 1:5480 BROADWAY APT 10F
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-7620
Mailing Address - Country:US
Mailing Address - Phone:917-750-4634
Mailing Address - Fax:
Practice Address - Street 1:5480 BROADWAY APT 10F
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-7620
Practice Address - Country:US
Practice Address - Phone:917-750-4634
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-21
Last Update Date:2016-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor