Provider Demographics
NPI:1043570104
Name:GRANT, ALYSON MARIE (MD)
Entity Type:Individual
Prefix:
First Name:ALYSON
Middle Name:MARIE
Last Name:GRANT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 NORTHERN BLVD STE 212
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-5200
Mailing Address - Country:US
Mailing Address - Phone:516-472-5700
Mailing Address - Fax:
Practice Address - Street 1:600 NORTHERN BLVD STE 212
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-5200
Practice Address - Country:US
Practice Address - Phone:516-472-5700
Practice Address - Fax:516-472-5714
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-23
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY284095-1207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty