Healthcare Provider Details

I. General information

NPI: 1124039490
Provider Name (Legal Business Name): ERIC GRUBMAN MD, FACC, NASPE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 07/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 DEVINE STREET SUITE # 1
NORTH HAVEN CT
06473-2193
US

IV. Provider business mailing address

2 DEVINE STREET SUITE # 1
NORTH HAVEN CT
06473-2193
US

V. Phone/Fax

Practice location:
  • Phone: 203-789-2272
  • Fax: 203-865-8614
Mailing address:
  • Phone: 203-789-2272
  • Fax: 203-865-8614

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number036758
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number036758
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: