Healthcare Provider Details

I. General information

NPI: 1093701278
Provider Name (Legal Business Name): JOHN ANDREW GRANT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2005
Last Update Date: 05/09/2024
Certification Date: 05/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MERRICK ROAD SUITE 100W
ROCKVILLE CENTRE NY
11570
US

IV. Provider business mailing address

100 MERRICK ROAD SUITE 100W
ROCKVILLE CENTRE NY
11570
US

V. Phone/Fax

Practice location:
  • Phone: 516-632-7050
  • Fax: 516-632-7074
Mailing address:
  • Phone: 516-632-7050
  • Fax: 516-632-7074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number0101282051
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License Number036-084798
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number264268
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number04-31027
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: