Healthcare Provider Details

I. General information

NPI: 1396042701
Provider Name (Legal Business Name): CITYWIDE HEALTH MEDICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2011
Last Update Date: 02/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

336 E 86TH ST
NEW YORK NY
10028-4615
US

IV. Provider business mailing address

336 E 86TH ST
NEW YORK NY
10028-4615
US

V. Phone/Fax

Practice location:
  • Phone: 888-929-7533
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. LEV GRINMAN
Title or Position: DIRECTOR
Credential:
Phone: 646-673-1660