Healthcare Provider Details

I. General information

NPI: 1215321666
Provider Name (Legal Business Name): GRAND MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2015
Last Update Date: 05/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 HIGGINS RD
CHESHIRE CT
06410-3326
US

IV. Provider business mailing address

258 GRAND AVE
NEW HAVEN CT
06513-3723
US

V. Phone/Fax

Practice location:
  • Phone: 914-374-3468
  • Fax:
Mailing address:
  • Phone: 914-374-3468
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number048491
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number048491
License Number StateCT

VIII. Authorized Official

Name: DR. SAMEER SYED
Title or Position: PHYSICIAN - OWNER OF LLC
Credential: MD
Phone: 914-374-3468