Provider Demographics
NPI:1154387645
Name:BRADY, GRANVILLE YORK JR (AUD)
Entity type:Individual
Prefix:DR
First Name:GRANVILLE
Middle Name:YORK
Last Name:BRADY
Suffix:JR
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 AUER CT STE C
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-5848
Mailing Address - Country:US
Mailing Address - Phone:327-387-2395
Mailing Address - Fax:327-387-2394
Practice Address - Street 1:10 AUER CT STE C
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816
Practice Address - Country:US
Practice Address - Phone:327-387-2395
Practice Address - Fax:327-387-2394
Is Sole Proprietor?:No
Enumeration Date:2006-04-24
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJYB00002231H00000X, 235Z00000X
NJ41YB00000200231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0051233Medicaid
NJ226095R55Medicare ID - Type Unspecified