MEDICARE: DR. PERMINDER S GREWAL MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	157708	NY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
15	110019900	OTHER	NY	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	54D492	OTHER	NY	EMPIRE BC WEST NYACK
2	733693	OTHER	NY	CONNECTICARE
3	114459	OTHER	NY	WELLCARE
4	157708	OTHER	NY	HIP
5	6008462	OTHER	NY	MVP/TACONIC IPA
6	000000014459	OTHER	NY	GHI HMO
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	0043771	OTHER	NY	AETNA HMO
9	13-3693126	OTHER	NY	TAX ID #
10	4061280	OTHER	NY	AETNA PPO
11	N33226	OTHER	NY	HEALTHNET
12	157708-9	OTHER	NY	WORKERS COMP
13	54D491	OTHER	NY	EMPIRE BC STONY POINT
14	RP034	OTHER	NY	OXFORD

General Provider Information

NPI Number	:	1053381715
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PERMINDER S GREWAL MD

Provider Business Mailing Address
First Line	:	20 GRAND ST
Second Line	:	FL 3
City	:	WARWICK
State	:	NY
Zip	:	10990-1035
Country	:	US
Telephone Number	:	845-942-1001
Fax Number	:	845-987-5979

Provider Business Practice Location Address
First Line	:	12 LIBERTY SQUARE MALL
Second Line	:
City	:	STONY POINT
State	:	NY
Zip	:	10980-2400
Country	:	US
Telephone Number	:	845-942-1001
Fax Number	:	845-942-1431

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/25/2006
Last Update Date	:	12/05/2016

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Directions to “ DR. PERMINDER S GREWAL MD” Practice Location

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