Healthcare Provider Details

I. General information

NPI: 1821081373
Provider Name (Legal Business Name): PAUL M.GRAPPELL,M.D.,JAMES T.WALKER,M.D.,P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2005
Last Update Date: 06/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

146 MANETTO HILL RD
PLAINVIEW NY
11803-1324
US

IV. Provider business mailing address

146 MANETTO HILL RD
PLAINVIEW NY
11803-1324
US

V. Phone/Fax

Practice location:
  • Phone: 516-822-3600
  • Fax: 516-822-0008
Mailing address:
  • Phone: 516-822-3600
  • Fax: 516-822-0008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number101823-1
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier00175448
Identifier TypeMEDICAID
Identifier StateNY
Identifier Issuer
# 2
Identifier01070488
Identifier TypeMEDICAID
Identifier StateNY
Identifier Issuer

VIII. Authorized Official

Name: DR. PAUL M GRAPPELL
Title or Position: PRESIDENT
Credential: MD
Phone: 516-822-3600