Healthcare Provider Details

I. General information

NPI: 1366007742
Provider Name (Legal Business Name): SAMUEL GRANT HILBERT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2019
Last Update Date: 01/31/2025
Certification Date: 01/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 BRADHURST AVE STE 800S
HAWTHORNE NY
10532-2198
US

IV. Provider business mailing address

19 SKYLINE DR OFC IN-J08
HAWTHORNE NY
10532-2134
US

V. Phone/Fax

Practice location:
  • Phone: 914-614-4270
  • Fax:
Mailing address:
  • Phone: 914-493-7997
  • Fax: 262-457-7432

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number316658
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number280406
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number316658-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: