Provider Demographics
NPI:1154182103
Name:ANNETTE JARRETT-GRAHAM
Entity type:Organization
Organization Name:ANNETTE JARRETT-GRAHAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:JARRETT-GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:516-817-7677
Mailing Address - Street 1:200 BROADHOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-4846
Mailing Address - Country:US
Mailing Address - Phone:516-817-7677
Mailing Address - Fax:319-220-3015
Practice Address - Street 1:200 BROADHOLLOW RD
Practice Address - Street 2:
Practice Address - City:MELVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747-4846
Practice Address - Country:US
Practice Address - Phone:516-817-7677
Practice Address - Fax:319-220-3015
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ANNETTE JARRETT-GRAHAM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-01-17
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty