MEDICARE: JESSICA J GRANT MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	238187	NY

General Provider Information

NPI Number	:	1699850057
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA J GRANT MD

Provider Business Mailing Address
First Line	:	2637 BROADWAY
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10025-5022
Country	:	US
Telephone Number	:	917-921-6219
Fax Number	:	646-880-8741

Provider Business Practice Location Address
First Line	:	2637 BROADWAY
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10025-5022
Country	:	US
Telephone Number	:	917-921-6219
Fax Number	:	646-880-8741

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/26/2006
Last Update Date	:	09/30/2025

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