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General NPI Number Information
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NPI Number | 1568485985
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Entity Type | Organization
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Legal Business Name | GRAND STREET MEDICAL PLLC
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Dates
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Enumeration Date | 07/26/2006
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Last Update Date | 04/18/2012
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Provider Practice Location Address
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Address Line | 666 GRAND ST
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City | BROOKLYN
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State | NY
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Zip | 11211-4853
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Country | US
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Telephone | 718-963-0555
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Fax | 718-963-4889
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Provider Business Mailing Address
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Address Line | 80 E END AVE 14-B
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City | NEW YORK
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State | NY
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Zip | 10028-8004
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Country | US
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Telephone | 212-734-9031
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Fax | 212-794-2441
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Authorized Official
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Title or Position | ADMINISTRATION
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Name | MRS. HEMA J GANDHI
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Credential |
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Telephone | 718-782-4768
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 111281
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 111281
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number | 111281
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License Number State | NY
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Taxonomy #4
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 111281
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License Number State | NY
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Taxonomy #5
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 111281
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License Number State | NY
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Taxonomy #6
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Taxonomy Code | 207QA0401X
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Taxonomy Name | Addiction Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 207RX0202X
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Taxonomy Name | Medical Oncology Physician
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License Number |
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License Number State |
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Taxonomy #10
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 111281
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License Number State | NY
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