Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | 162736 | NY |
NPI | 1598761819 |
---|---|
Provider Name | Samuel Grubman |
First Address | New York, NY 10003-5124 |
Second Address | New York, NY 10011-7330 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2005 |
Last Update Date | 25/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01586736 | (05) | NY |
A61694 | (02) | NY |