Healthcare Provider Details

I. General information

NPI: 1134877822
Provider Name (Legal Business Name): JOSEPH GRIMES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2022
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 W 168TH ST
NEW YORK NY
10032-3725
US

IV. Provider business mailing address

45 W 60TH ST APT 16F
NEW YORK NY
10023-7943
US

V. Phone/Fax

Practice location:
  • Phone: 212-305-2862
  • Fax:
Mailing address:
  • Phone: 650-464-1029
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number344962
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: