| Grace Medical Group Llc | |
|
1600 Saint Georges Ave Ste 118 Rahway NJ 07065-2713 | |
| (732) 596-1088 | |
| Not Available |
| Full Name | Grace Medical Group Llc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 1600 Saint Georges Ave Ste 118, Rahway, New Jersey |
| Authorized Official Name and Position | Akinlabi Adetayo Sanusi (PRESIDENT) |
| Authorized Official Contact | 7325961088 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Grace Medical Group Llc 1600 Saint Georges Ave Ste 118 Rahway NJ 07065-2713 Ph: (732) 596-1088 | Grace Medical Group Llc 1600 Saint Georges Ave Ste 118 Rahway NJ 07065-2713 Ph: (732) 596-1088 |
| NPI Number | 1003323155 |
|---|---|
| Provider Enumeration Date | 01/10/2018 |
| Last Update Date | 01/10/2018 |
| Medicare PECOS PAC ID | 0446510895 |
|---|---|
| Medicare Enrollment ID | O20180205001750 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003323155 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Akinlabi Adetayo Sanusi |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1790126803 PECOS PAC ID: 6103123088 Enrollment ID: I20160321000081 |
| Provider Name | Stacey-ann D Lambert |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1073019428 PECOS PAC ID: 2163786567 Enrollment ID: I20180511001582 |
| Provider Name | Tina M Butler |
|---|---|
| Provider Type | Practitioner - Other (non-physician) |
| Provider Identifiers | NPI Number: 1790997575 PECOS PAC ID: 4789937038 Enrollment ID: I20181102001178 |
| Provider Name | Anastasia A Krosnick |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1629552245 PECOS PAC ID: 6709130032 Enrollment ID: I20181126001526 |
| Provider Name | Ugochi Abazie |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1932675592 PECOS PAC ID: 8729318282 Enrollment ID: I20190925002914 |
| Provider Name | Martine J Jones |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265082812 PECOS PAC ID: 2567896939 Enrollment ID: I20191218002674 |
| Provider Name | Christopher Castro |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1114525045 PECOS PAC ID: 6002252574 Enrollment ID: I20240307001375 |
| Provider Name | Valencia Henry |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1104414903 PECOS PAC ID: 6901348994 Enrollment ID: I20240605002725 |
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