Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | X005485 | NY |
NPI | 1760693238 |
---|---|
Provider Name | Dr. Michael Anthony Gruttadauria |
First Address | Plainview, NY 11803-4017 |
Second Address | Plainview, NY 11803-4017 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/05/2007 |
Last Update Date | 08/07/2007 |