Healthcare Provider Details

I. General information

NPI: 1386135051
Provider Name (Legal Business Name): GRANGER & SAHASRA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2018
Last Update Date: 05/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1103 STEWART AVENUE SUITE 104
GARDEN CITY NY
11530
US

IV. Provider business mailing address

1103 STEWART AVENUE SUITE 104
GARDEN CITY NY
11530
US

V. Phone/Fax

Practice location:
  • Phone: 516-222-1822
  • Fax: 516-227-5361
Mailing address:
  • Phone: 516-222-1822
  • Fax: 516-227-5361

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number StateNY

VIII. Authorized Official

Name: DR. ASHISH SAHUSRABUDHE
Title or Position: OWNER
Credential: DMD
Phone: 516-222-1822