Provider Demographics
NPI:1689138976
Name:GRAHAME, GILLIAN
Entity Type:Individual
Prefix:
First Name:GILLIAN
Middle Name:
Last Name:GRAHAME
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 1:25 POND VIEW DR
Mailing Address - Street 2:
Mailing Address - City:WEST MILFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07480-3016
Mailing Address - Country:US
Mailing Address - Phone:201-247-3111
Mailing Address - Fax:
Practice Address - Street 1:300 POMPTON RD
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-2103
Practice Address - Country:US
Practice Address - Phone:201-247-3111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-30
Last Update Date:2019-10-17
Deactivation Date:2019-01-30
Deactivation Code:
Reactivation Date:2019-10-17
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer