Provider Demographics
NPI:1932807039
Name:GRACE FORDE MD PC
Entity Type:Organization
Organization Name:GRACE FORDE MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:
Authorized Official - Last Name:FORDE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-233-2634
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-17
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty