Provider Demographics
NPI:1942827340
Name:GRAY, MICHELLE L (DIALYSIS TECHNICIAN)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:L
Last Name:GRAY
Suffix:
Gender:F
Credentials:DIALYSIS TECHNICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1415 JOSEPH ST
Mailing Address - Street 2:
Mailing Address - City:POINT PLEASANT BORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08742-4571
Mailing Address - Country:US
Mailing Address - Phone:732-998-6447
Mailing Address - Fax:732-222-3816
Practice Address - Street 1:18 GULL POINT RD
Practice Address - Street 2:
Practice Address - City:MONMOUTH BEACH
Practice Address - State:NJ
Practice Address - Zip Code:07750-1007
Practice Address - Country:US
Practice Address - Phone:732-998-6447
Practice Address - Fax:732-222-3816
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-01
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ0450473998156F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156F00000XEye and Vision Services ProvidersTechnician/TechnologistGroup - Single Specialty