Healthcare Provider Details

I. General information

NPI: 1861466278
Provider Name (Legal Business Name): GREGORY ERSKINE GRANT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1585 3RD ST
FORT POLK LA
71459-5102
US

IV. Provider business mailing address

24 HIGHLAND PL
BROOKLYN NY
11208-1219
US

V. Phone/Fax

Practice location:
  • Phone: 726-780-2154
  • Fax:
Mailing address:
  • Phone: 718-791-8653
  • Fax: 347-402-2783

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number233767
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: