Provider Demographics
NPI:1548338254
Name:GRANVILLE Y BRADY JR AUD PA
Entity type:Organization
Organization Name:GRANVILLE Y BRADY JR AUD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GRANVILLE
Authorized Official - Middle Name:YORK
Authorized Official - Last Name:BRADY
Authorized Official - Suffix:JR
Authorized Official - Credentials:AUD
Authorized Official - Phone:732-387-2395
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:732-387-2395
Mailing Address - Fax:323-872-3947
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:732-387-2395
Practice Address - Fax:732-387-2394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3297501Medicaid
NJ0051233Medicaid
NJ3297501Medicaid