Provider Demographics
NPI:1770136814
Name:GRAY-WALKER, TRACEY C
Entity type:Individual
Prefix:
First Name:TRACEY
Middle Name:C
Last Name:GRAY-WALKER
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 1:150 MAPLE AVE STE 141
Mailing Address - Street 2:
Mailing Address - City:SOUTH PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07080-3407
Mailing Address - Country:US
Mailing Address - Phone:908-209-1193
Mailing Address - Fax:908-753-4327
Practice Address - Street 1:1355 MARTINE AVE
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07060-3127
Practice Address - Country:US
Practice Address - Phone:908-209-1193
Practice Address - Fax:908-753-4327
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-18
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care