Healthcare Provider Details

I. General information

NPI: 1003961699
Provider Name (Legal Business Name): SUSAN L.GRANT, M.D.,P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 02/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 E 83RD ST
NEW YORK NY
10028-0418
US

IV. Provider business mailing address

8 E 83RD ST
NEW YORK NY
10028-0418
US

V. Phone/Fax

Practice location:
  • Phone: 212-769-0755
  • Fax:
Mailing address:
  • Phone: 212-769-0755
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number143686
License Number StateNY

VIII. Authorized Official

Name: DR. SUSAN L GRANT
Title or Position: PRESIDENT
Credential: M.D.
Phone: 212-760-0755