Healthcare Provider Details

I. General information

NPI: 1053381715
Provider Name (Legal Business Name): PERMINDER S GREWAL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2006
Last Update Date: 12/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 LIBERTY SQUARE MALL
STONY POINT NY
10980-2400
US

IV. Provider business mailing address

20 GRAND ST FL 3
WARWICK NY
10990-1035
US

V. Phone/Fax

Practice location:
  • Phone: 845-942-1001
  • Fax: 845-942-1431
Mailing address:
  • Phone: 845-942-1001
  • Fax: 845-987-5979

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number157708
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: