Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0000X | Internist - Cardiovascular Disease | 036758 | CT |
Y | 207RC0001X | Clinical Cardiac Electrophysiologist | 036758 | CT |
NPI | 1124039490 |
---|---|
Provider Name | Dr. Eric Grubman |
First Address | North Haven, CT 06473-2193 |
Second Address | North Haven, CT 06473-2193 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2006 |
Last Update Date | 08/07/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001367582 | (05) | CT |
060050666 | MEDICARE RAILROAD PIN (01) | CT |
G66303 | (02) | CT |