Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 210646 | NY |
Y | 111NI0900X | Internist | 210646 | NY |
N | 207RG0300X | Geriatric Medicine | 210646 | NY |
N | 207RH0002X | Hospice and Palliative Medicine | 210646 | NY |
NPI | 1295878866 |
---|---|
Provider Name | Dr. Heather Grant |
First Address | Northport, NY 11768-3900 |
Second Address | Northport, NY 11768-3900 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/02/2007 |
Last Update Date | 08/10/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H55317 | (02) | NY |