Healthcare Provider Details

I. General information

NPI: 1033111265
Provider Name (Legal Business Name): ROBERT S. GRIMSHAW, JR. M.D., F.A.C.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2005
Last Update Date: 11/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3535 HILL BLVD STE R CARE MOUNT MEDICAL PC
YORKTOWN HTS NY
10598-1209
US

IV. Provider business mailing address

110 S BEDFORD RD CARE MOUNT MEDICAL, PC
MOUNT KISCO NY
10549-3446
US

V. Phone/Fax

Practice location:
  • Phone: 914-962-3180
  • Fax: 914-242-1516
Mailing address:
  • Phone: 914-962-3180
  • Fax: 914-242-1516

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number143759-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number143759-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: