Healthcare Provider Details

I. General information

NPI: 1295871879
Provider Name (Legal Business Name): ELI GRUNSTEIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3959 BROADWAY 5TH FLOOR ROOM 501N
NEW YORK NY
10032-1559
US

IV. Provider business mailing address

3959 BROADWAY 5TH FLOOR ROOM 501N
NEW YORK NY
10032-1559
US

V. Phone/Fax

Practice location:
  • Phone: 212-305-8933
  • Fax: 212-342-6401
Mailing address:
  • Phone: 212-305-8933
  • Fax: 212-342-3908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number228604
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207YP0228X
TaxonomyPediatric Otolaryngology Physician
License Number228604
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: