Provider Demographics
NPI:1356191258
Name:OLYFVELDT BYNOE, GRACE M
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:M
Last Name:OLYFVELDT BYNOE
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 1:15 VALLEY ST STE 1
Mailing Address - Street 2:
Mailing Address - City:SOUTH ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07079-2809
Mailing Address - Country:US
Mailing Address - Phone:973-280-1922
Mailing Address - Fax:
Practice Address - Street 1:15 VALLEY ST STE 1
Practice Address - Street 2:
Practice Address - City:SOUTH ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07079-2809
Practice Address - Country:US
Practice Address - Phone:973-280-1922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management