MEDICARE: SAUL GRULLON M.D.

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	208000000X	Pediatrics Physician	P03103	NY
2	207P00000X	Emergency Medicine Physician	ME158371	FL
3	207P00000X	Emergency Medicine Physician	30534601	NY
4	207P00000X	Emergency Medicine Physician	60059	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518412311
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAUL GRULLON M.D.

Provider Business Mailing Address
First Line	:	374 STOCKHOLM ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11237-4006
Country	:	US
Telephone Number	:	718-963-7272
Fax Number	:

Provider Business Practice Location Address
First Line	:	7848 73RD PL
Second Line	:
City	:	GLENDALE
State	:	NY
Zip	:	11385-7426
Country	:	US
Telephone Number	:	718-963-7272
Fax Number	:

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

Provider Enumeration Date	:	08/22/2016
Last Update Date	:	04/08/2026

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