Provider Demographics
NPI:1912308636
Name:GARAY, MIRYAM D
Entity Type:Individual
Prefix:
First Name:MIRYAM
Middle Name:D
Last Name:GARAY
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 1:80 ROUTE 6
Mailing Address - Street 2:STE 704-706
Mailing Address - City:BALDWIN PLACE
Mailing Address - State:NY
Mailing Address - Zip Code:10505-1026
Mailing Address - Country:US
Mailing Address - Phone:914-843-3626
Mailing Address - Fax:
Practice Address - Street 1:731 WHITE PLAINS RD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10473
Practice Address - Country:US
Practice Address - Phone:718-589-8775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-12
Last Update Date:2017-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY23017980363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical