Provider Demographics
NPI:1255513487
Name:GRACE MEDICAL CARE, PLLC
Entity type:Organization
Organization Name:GRACE MEDICAL CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BIN
Authorized Official - Middle Name:
Authorized Official - Last Name:WANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-886-7888
Mailing Address - Street 1:48 KENSINGTON CIR
Mailing Address - Street 2:
Mailing Address - City:MANHASSET
Mailing Address - State:NY
Mailing Address - Zip Code:11030-4106
Mailing Address - Country:US
Mailing Address - Phone:718-886-7888
Mailing Address - Fax:718-886-9120
Practice Address - Street 1:13347 SANFORD AVE STE C1G
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-5816
Practice Address - Country:US
Practice Address - Phone:718-886-7888
Practice Address - Fax:718-886-9120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-29
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY217425207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH17816Medicare UPIN