Provider Demographics
NPI:1891024113
Name:JEFFERY JEROME GRACE, MD, PC
Entity Type:Organization
Organization Name:JEFFERY JEROME GRACE, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:JEROME
Authorized Official - Last Name:GRACE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:716-882-1221
Mailing Address - Street 1:PO BOX 1053
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14213-7053
Mailing Address - Country:US
Mailing Address - Phone:716-882-1221
Mailing Address - Fax:716-884-0602
Practice Address - Street 1:1300 NIAGARA ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14213-1503
Practice Address - Country:US
Practice Address - Phone:716-882-1221
Practice Address - Fax:716-884-0602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-16
Last Update Date:2009-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1633712084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty