Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RA0401X | Internist - Addiction Medicine | 178231 | NY |
N | 207RR0500X | Rheumatology | 178231 | NY |
NPI | 1851326177 |
---|---|
Provider Name | Michael W Grisanti |
First Address | Orchard Park, NY 14127-1231 |
Second Address | Orchard Park, NY 14127-1231 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01164525 | (05) | NY |
E19649 | (02) |