Provider Demographics
NPI:1851620108
Name:GRAN, VALENTINA (CMT)
Entity Type:Individual
Prefix:MRS
First Name:VALENTINA
Middle Name:
Last Name:GRAN
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 NUNDA AVE
Mailing Address - Street 2:APT. 2
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07304-1309
Mailing Address - Country:US
Mailing Address - Phone:973-508-4956
Mailing Address - Fax:
Practice Address - Street 1:16 NUNDA AVE
Practice Address - Street 2:APT. 2
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07304-1309
Practice Address - Country:US
Practice Address - Phone:973-508-4956
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-16
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ18KT00148400225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ47-5467655OtherEIN