MEDICARE: DAISY GRUESO D.O.

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	207V00000X	Obstetrics & Gynecology Physician	207470-1	NY

General Provider Information

NPI Number	:	1174568851
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAISY GRUESO D.O.

Provider Business Mailing Address
First Line	:	2094 PITKIN AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11207-3509
Country	:	US
Telephone Number	:	718-240-0400
Fax Number	:	718-240-0437

Provider Business Practice Location Address
First Line	:	451 CLARKSON AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11203-2054
Country	:	US
Telephone Number	:	718-245-4577
Fax Number	:

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

Provider Enumeration Date	:	06/18/2006
Last Update Date	:	04/07/2015

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