MEDICARE: MR. JOEL GRUNWALD

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	235Z00000X	Speech-Language Pathologist		NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1115191702	OTHER	NY	UNITED HEALTHCARE OXFORD

General Provider Information

NPI Number	:	1467890863
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOEL GRUNWALD

Provider Business Mailing Address
First Line	:	1220 48TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11219-3009
Country	:	US
Telephone Number	:	917-627-9897
Fax Number	:

Provider Business Practice Location Address
First Line	:	1220 48TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11219-3009
Country	:	US
Telephone Number	:	917-627-9897
Fax Number	:

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

Provider Enumeration Date	:	06/06/2013
Last Update Date	:	08/02/2013

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Directions to “ MR. JOEL GRUNWALD ” Practice Location

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