Sandra D Gray, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

22D101572500 Issued in NJ

Practice address

444 William St
East Orange, NJ 07017-2213

Phone

(973) 675-1900

Fax

(973) 675-4021

NPI assigned

Dec 12, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Sandra Phiilp-Rousseau Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Interoperability endpoints

• Direct secure messaging: sandra.gray@nchc.eclinicaldirectplus.com

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1165881600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1212451200000",
    "number": "1205997608",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "61 PARKSIDE DR",
            "city": "BELLEVILLE",
            "state": "NJ",
            "postal_code": "071091602"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "444 WILLIAM ST",
            "city": "EAST ORANGE",
            "state": "NJ",
            "postal_code": "070172213",
            "telephone_number": "973-675-1900",
            "fax_number": "973-675-4021"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRAY",
        "first_name": "SANDRA",
        "middle_name": "D",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-12",
        "last_updated": "2008-06-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NJ",
            "license": "22D101572500",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "444 WILLIAM STREET",
            "identifier": "1194996645",
            "state": "NJ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1836706",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SANDRA",
            "last_name": "PHIILP-ROUSSEAU",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Dentist in East Orange, NJ
• Providers in East Orange, NJ by specialty
• Dentist in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.