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General NPI Number Information
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NPI Number | 1619010493
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Entity Type | Organization
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Legal Business Name | GRIAL MEDICAL, P.C.
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Dates
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Enumeration Date | 02/14/2007
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Last Update Date | 09/20/2007
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Provider Practice Location Address
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Address Line | 9913 3RD AVE
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City | BROOKLYN
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State | NY
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Zip | 11209-7935
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Country | US
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Telephone | 718-630-9955
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Fax | 718-630-9956
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Provider Business Mailing Address
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Address Line | 9913 3RD AVE
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City | BROOKLYN
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State | NY
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Zip | 11209-7935
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Country | US
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Telephone | 718-630-9955
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Fax | 718-630-9956
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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 | M.D.
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Telephone | 718-630-9955
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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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