Basic Information
| Provider Information | |||||||||
| NPI: | 1992883557 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GRIGAUX | ||||||||
| FirstName: | CLAIRE | ||||||||
| MiddleName: | NATHALIE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 416457 | ||||||||
| Address2: | |||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 022416457 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1000 GALLOPING HILL ROAD | ||||||||
| Address2: | DEVELOPMENTAL DISABILITIES CENTER | ||||||||
| City: | UNION | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 07083 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9085986655 | ||||||||
| FaxNumber: | 9086868374 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/01/2006 | ||||||||
| LastUpdateDate: | 11/23/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | A83392 | CA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 25MA08546700 | NJ | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 00A833920 | 05 | CA | MEDICAID |