Healthcare Provider Details

I. General information

NPI: 1952506792
Provider Name (Legal Business Name): GRAND CENTRAL PHYSICAL MEDICINE&REHABILITATION PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2007
Last Update Date: 02/03/2020
Certification Date: 02/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 MADISON AVE RM 702
NEW YORK NY
10017-5434
US

IV. Provider business mailing address

315 MADISON AVE RM 702
NEW YORK NY
10017-5434
US

V. Phone/Fax

Practice location:
  • Phone: 212-867-0405
  • Fax:
Mailing address:
  • Phone: 212-867-0405
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DORINA A DRUKMAN
Title or Position: OWNER
Credential: D.O.
Phone: 212-867-0405