Provider Demographics
NPI:1477817237
Name:RAY, GERIANNE MARY (MA)
Entity type:Individual
Prefix:MRS
First Name:GERIANNE
Middle Name:MARY
Last Name:RAY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 JUNARD BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11776-2013
Mailing Address - Country:US
Mailing Address - Phone:631-331-5931
Mailing Address - Fax:
Practice Address - Street 1:25 JUNARD BLVD
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON STATION
Practice Address - State:NY
Practice Address - Zip Code:11776-2013
Practice Address - Country:US
Practice Address - Phone:631-331-5931
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-26
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist