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General NPI Number Information
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NPI Number | 1104936061
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Entity Type | Organization
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Legal Business Name | MARTIN I GRANOFF MD PC
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 12/07/2007
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Provider Practice Location Address
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Address Line | 554 LARKFIELD ROAD SUTIE 105
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City | EAST NORTHPORT
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State | NY
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Zip | 11731
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Country | US
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Telephone | 631-369-3800
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Fax | 631-368-3802
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Provider Business Mailing Address
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Address Line | PO BOX 899
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City | EAST NORTHPORT
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State | NY
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Zip | 11731-0526
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Country | US
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Telephone | 631-369-3800
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Fax | 631-368-3802
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Authorized Official
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Title or Position | PHYSICIAN
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Name | MARTIN IRVING GRANOFF
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Credential | MD
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Telephone | 631-369-3800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 211787
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License Number State | NY
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