Healthcare Provider Details

I. General information

NPI: 1518412311
Provider Name (Legal Business Name): SAUL GRULLON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2016
Last Update Date: 04/08/2026
Certification Date: 04/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7848 73RD PL
GLENDALE NY
11385-7426
US

IV. Provider business mailing address

374 STOCKHOLM ST
BROOKLYN NY
11237-4006
US

V. Phone/Fax

Practice location:
  • Phone: 718-963-7272
  • Fax:
Mailing address:
  • Phone: 718-963-7272
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberP03103
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberME158371
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number30534601
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number60059
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: