Provider Demographics
NPI:1164501219
Name:GRANT, DOV Z (MD)
Entity Type:Individual
Prefix:DR
First Name:DOV
Middle Name:Z
Last Name:GRANT
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 1:121 E 60TH ST APT 9B
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-1198
Mailing Address - Country:US
Mailing Address - Phone:212-230-1945
Mailing Address - Fax:212-230-1592
Practice Address - Street 1:121 E 60TH ST APT 9B
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-1198
Practice Address - Country:US
Practice Address - Phone:212-230-1945
Practice Address - Fax:212-230-1592
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY119134207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJC-08182Medicare UPIN
NYDG03096910Medicare PIN