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General NPI Number Information
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NPI Number | 1629290580
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Entity Type | Individual
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Provider Name | JEAN JOSEPH GRANDOIT PHYSICIAN'S ASSISTAN
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Gender | Male
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Dates
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Enumeration Date | 05/02/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2176 NOSTRAND AVENUE
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City | BROOKLYN
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State | NY
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Zip | 11210-0823
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Country | US
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Telephone | 646-330-8254
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Fax |
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Provider Business Mailing Address
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Address Line | P.O.BOX 100823
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City | BROOKLYN
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State | NY
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Zip | 11210-0823
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Country | US
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Telephone | 646-330-8254
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 002867
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License Number State | NY
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