Physician Compare National (NPI:1376521781)

HEALTHCARE PROVIDER: JEROLD M GRODIN PHD

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1376521781
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	4789878026
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20101101001048
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	GRODIN
	Individual professional last name
Provider First Name	JEROLD
	Individual professional first name
Provider Middle Name	M
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	NEW YORK UNIVERSITY SCHOOL OF MEDICINE
	Individual professional's medical school
Graduation Year	1983
	Individual professional's medical school graduation year
Primary Specialty	PSYCHOLOGIST, CLINICAL
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	526 MAPLE AVE
	Group Practice or individual's line 1 address
City	SARATOGA SPRINGS
	Group Practice or individual's city
State	NY
	Group Practice or individual's state
Zip Code	128665861
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y