Basic Information
| Provider Information | |||||||||
| NPI: | 1487619003 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GRANOWITZ | ||||||||
| FirstName: | GAIL | ||||||||
| MiddleName: | F | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 285 DAVIDSON AVE | ||||||||
| Address2: | SUITE 301 | ||||||||
| City: | SOMERSET | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 088734153 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7322711400 | ||||||||
| FaxNumber: | 7322713543 | ||||||||
| Practice Location | |||||||||
| Address1: | 285 DAVIDSON AVE | ||||||||
| Address2: | ACNJ - THIRD FLOOR | ||||||||
| City: | SOMERSET | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 088734153 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7322711400 | ||||||||
| FaxNumber: | 7322713543 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/18/2006 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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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 | 207L00000X | MA61010 | NJ | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 6425607 | 05 | NJ | MEDICAID | F98756 | 01 | NJ | PROVIDER # | OTHER |