Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 143759-1 | NY |
Y | 111NI0900X | Internist | 143759-1 | NY |
N | 207RG0300X | Geriatric Medicine | 143759-1 | NY |
NPI | 1033111265 |
---|---|
Provider Name | Robert S. Grimshaw, Jr. |
First Address | Mount Kisco, NY 10549-3446 |
Second Address | Yorktown Hts, NY 10598-1209 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2005 |
Last Update Date | 11/11/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00693274 | (05) | NY |
143759-9 CIM | WORKERS COMP (01) | NY |
B78796 | (02) | NY |