Provider Demographics
NPI:1508861816
Name:FORDE, GRACE (MD)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:FORDE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1991 MARCUS AVE STE M217
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11042-2040
Mailing Address - Country:US
Mailing Address - Phone:516-233-2634
Mailing Address - Fax:516-233-2635
Practice Address - Street 1:1991 MARCUS AVE STE M217
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-2040
Practice Address - Country:US
Practice Address - Phone:516-233-2634
Practice Address - Fax:516-233-2635
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2023-09-06
Deactivation Date:2023-08-21
Deactivation Code:
Reactivation Date:2023-08-31
Provider Licenses
StateLicense IDTaxonomies
NY207390207L00000X, 207LC0200X, 208VP0000X, 208VP0014X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LC0200XAllopathic & Osteopathic PhysiciansAnesthesiologyCritical Care Medicine
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01775795Medicaid
NYG54260Medicare UPIN
NY01775795Medicaid
NY05785PMedicare ID - Type UnspecifiedGHI MEDICARE