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Contact Information

EDA GRAHAM
2025 ROUTE 9W
RAVENA, NY12143
 Phone: 518-935-8258
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

School

101YS0200X
Indicates primary specialty

NPI Profile & details for EDA GRAHAM · (Female)

NPI # 1558087296
Status Active
Credentials
Entity Individual
Enumeration date 10/14/2022
Last updated 10/14/2022 - About 4 years ago
Sole proprietor 1 No
Identifiers
  • NY License # 117708
  • NY Medicaid 117708
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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