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NPI Code Detail

MEDICARE: ALEXIS GRUCELA M.D.

MEDICARE: ALEXIS GRUCELA 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
1208C00000XColon & Rectal Surgery Physician243598NY

General Provider Information

NPI Number : 1841459385
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALEXIS GRUCELA M.D.
Provider Business Mailing Address
First Line : 480 BEDFORD RD BLDG D
Second Line :
City : CHAPPAQUA
State : NY
Zip : 10514-1715
Country : US
Telephone Number : 914-242-1360
Fax Number :
Provider Business Practice Location Address
First Line : 480 BEDFORD RD BLDG D
Second Line :
City : CHAPPAQUA
State : NY
Zip : 10514-1715
Country : US
Telephone Number : 914-242-1360
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/09/2008
Last Update Date : 04/12/2025

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