Provider Demographics
NPI:1891837944
Name:GRAHAM WINDHAM
Entity Type:Organization
Organization Name:GRAHAM WINDHAM
Other - Org Name:GRAHAM WINDHAM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:BASIL
Authorized Official - Middle Name:
Authorized Official - Last Name:WEBSTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-529-6445
Mailing Address - Street 1:1 PIERREPONT PLZ
Mailing Address - Street 2:SUITE 901
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-2790
Mailing Address - Country:US
Mailing Address - Phone:212-529-6445
Mailing Address - Fax:212-260-2147
Practice Address - Street 1:1 PIERREPONT PLZ
Practice Address - Street 2:SUITE 901
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-2790
Practice Address - Country:US
Practice Address - Phone:212-529-6445
Practice Address - Fax:212-260-2147
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00327995Medicaid
NY03036775Medicaid
NY00698673Medicaid
NY02997877Medicaid