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General NPI Number Information
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NPI Number | 1215986773
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Entity Type | Individual
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Provider Name | KENNETH P. GRUSH MD
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Gender | Male
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Dates
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Enumeration Date | 05/10/2006
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Last Update Date | 04/30/2008
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Provider Practice Location Address
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Address Line | 57 MONTAGUE STREET APT 8A
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City | BROOKLYN
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State | NY
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Zip | 11201-3358
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Country | US
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Telephone | 917-882-3587
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Fax |
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Provider Business Mailing Address
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Address Line | 57 MONTAGUE STREET APT 8A
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City | BROOKLYN
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State | NY
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Zip | 11201-3358
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 25MA05061300
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 156424 1
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | MD 014741
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License Number State | LA
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