Healthcare Provider Details

I. General information

NPI: 1598891475
Provider Name (Legal Business Name): SAMUEL GRUBMAN M.D.,P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 01/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

154 W 14TH ST 4TH FL
NEW YORK NY
10011-7307
US

IV. Provider business mailing address

70 E 10TH ST APT 12K
NEW YORK NY
10003-5102
US

V. Phone/Fax

Practice location:
  • Phone: 212-616-4122
  • Fax: 212-616-4124
Mailing address:
  • Phone: 212-616-4122
  • Fax: 212-616-4124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number162736
License Number StateNY

VIII. Authorized Official

Name: SAMUEL GRUBMAN
Title or Position: DOCTOR
Credential: M.D.,P.C.
Phone: 212-616-4122