Provider Demographics
NPI:1033111265
Name:GRIMSHAW, JR., ROBERT S (MD, FACP)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:S
Last Name:GRIMSHAW, JR.
Suffix:
Gender:M
Credentials:MD, FACP
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:110 S BEDFORD RD
Mailing Address - Street 2:CARE MOUNT MEDICAL, PC
Mailing Address - City:MOUNT KISCO
Mailing Address - State:NY
Mailing Address - Zip Code:10549-3446
Mailing Address - Country:US
Mailing Address - Phone:914-962-3180
Mailing Address - Fax:914-242-1516
Practice Address - Street 1:3535 HILL BLVD STE R
Practice Address - Street 2:CARE MOUNT MEDICAL PC
Practice Address - City:YORKTOWN HTS
Practice Address - State:NY
Practice Address - Zip Code:10598-1209
Practice Address - Country:US
Practice Address - Phone:914-962-3180
Practice Address - Fax:914-242-1516
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2016-11-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY143759-1207R00000X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY143759-9 CIMOtherWORKERS COMP
NY00693274Medicaid
NY143759-9 CIMOtherWORKERS COMP
NYB78796Medicare UPIN
NY110004275Medicare ID - Type UnspecifiedRAILROAD MEDICARE
NY66A261Medicare ID - Type Unspecified