Provider Demographics
NPI:1023036613
Name:GRUNSEID, FRED (MD)
Entity Type:Individual
Prefix:DR
First Name:FRED
Middle Name:
Last Name:GRUNSEID
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1687 RALPH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-3319
Mailing Address - Country:US
Mailing Address - Phone:718-251-7191
Mailing Address - Fax:718-209-1891
Practice Address - Street 1:1687 RALPH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236-3319
Practice Address - Country:US
Practice Address - Phone:718-251-7191
Practice Address - Fax:718-209-1891
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2007-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY166169207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA65166Medicare UPIN