Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 033089 | NY |
NPI | 1134393549 |
---|---|
Provider Name | Dr. Richard Grunebaum |
First Address | New York, NY 10022-5403 |
Second Address | New York, NY 10022-5403 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/04/2008 |
Last Update Date | 16/04/2008 |