Provider Demographics
NPI:1174300305
Name:GRAVADOR, HAROLD CHRISTIAN DORIMAN
Entity type:Individual
Prefix:
First Name:HAROLD CHRISTIAN
Middle Name:DORIMAN
Last Name:GRAVADOR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9243 51ST AVE
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-4013
Mailing Address - Country:US
Mailing Address - Phone:929-504-8462
Mailing Address - Fax:
Practice Address - Street 1:1980 AMSTERDAM AVE UNIT 1B
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-5058
Practice Address - Country:US
Practice Address - Phone:718-839-3046
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-12
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048563225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist