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General NPI Number Information
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NPI Number | 1659054187
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Entity Type | Individual
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Provider Name | MS. MARIE CARMEL GRUBE
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Gender | Female
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Dates
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Enumeration Date | 08/10/2023
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Last Update Date | 08/10/2023
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Provider Practice Location Address
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Address Line | 158 WEST 56TH STREET SUITE 1804
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City | NEW YORK
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State | NY
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Zip | 10019
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Country | US
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Telephone | 212-662-9200
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Fax |
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Provider Business Mailing Address
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Address Line | 42 ACKERMAN PL
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City | NYACK
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State | NY
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Zip | 10960-2106
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Country | US
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Telephone | 646-379-2742
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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 | 405300000X
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Taxonomy Name | Prevention Professional
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License Number | 192211021
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 405300000X
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Taxonomy Name | Prevention Professional
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License Number | 902106991
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License Number State | NY
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