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General NPI Number Information
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NPI Number | 1396817094
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Entity Type | Organization
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Legal Business Name | GRIGORY SHTENDER PHYSICIAN,PC
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Dates
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Enumeration Date | 11/15/2006
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Last Update Date | 09/20/2007
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Provider Practice Location Address
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Address Line | 3001 BRIGHTON 1ST ST
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City | BROOKLYN
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State | NY
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Zip | 11235-8008
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Country | US
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Telephone | 718-368-0100
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Fax | 718-368-1208
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Provider Business Mailing Address
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Address Line | 139 QUENTIN RD
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City | BROOKLYN
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State | NY
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Zip | 11223-1201
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Country | US
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Telephone | 718-368-0100
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Fax | 718-368-1208
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Authorized Official
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Title or Position | PRESIDENT
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Name | GRIGORY SHTENDER
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Credential | MD
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Telephone | 718-368-0100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 218261
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License Number State | NY
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