Basic Information
| Provider Information | |||||||||
| NPI: | 1912308636 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GARAY | ||||||||
| FirstName: | MIRYAM | ||||||||
| MiddleName: | D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 80 ROUTE 6 | ||||||||
| Address2: | STE 704-706 | ||||||||
| City: | BALDWIN PLACE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105051026 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9148433626 | ||||||||
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| Practice Location | |||||||||
| Address1: | 731 WHITE PLAINS RD | ||||||||
| Address2: | |||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10473 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7185898775 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/12/2014 | ||||||||
| LastUpdateDate: | 05/05/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | 23017980 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.