Provider Demographics
NPI:1083607576
Name:PAUL M.GRAPPELL,M.D.,JAMES T.WALKER,M.D.,P.C.
Entity Type:Organization
Organization Name:PAUL M.GRAPPELL,M.D.,JAMES T.WALKER,M.D.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:M
Authorized Official - Last Name:GRAPPELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-422-4474
Mailing Address - Street 1:500 MONTAUK HWY
Mailing Address - Street 2:
Mailing Address - City:WEST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11795-4418
Mailing Address - Country:US
Mailing Address - Phone:631-422-4474
Mailing Address - Fax:631-422-1235
Practice Address - Street 1:500 MONTAUK HWY
Practice Address - Street 2:
Practice Address - City:WEST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11795-4418
Practice Address - Country:US
Practice Address - Phone:631-422-4474
Practice Address - Fax:631-422-1235
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-30
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1018231174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00175448Medicaid
NY01070488Medicaid
NY516391Medicare UPIN
NY00175448Medicaid
NY97A101Medicare ID - Type UnspecifiedDR.JAMES T.WALKER(PIN)
NY01070488Medicaid
W23972Medicare PIN