Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | NYS143686 | NY |
NPI | 1003994203 |
---|---|
Provider Name | Dr. Susan L Grant |
First Address | New York, NY 10024 |
Second Address | New York, NY 10024 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2006 |
Last Update Date | 31/01/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B79956 | (02) |