Provider Demographics
NPI:1205215266
Name:GRANT, BRIAN P (NPP)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:P
Last Name:GRANT
Suffix:
Gender:M
Credentials:NPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 DALFONSO RD
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550-7203
Mailing Address - Country:US
Mailing Address - Phone:845-541-3145
Mailing Address - Fax:
Practice Address - Street 1:54 DALFONSO RD
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-7203
Practice Address - Country:US
Practice Address - Phone:845-541-3145
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-23
Last Update Date:2021-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF403508363LP0808X
NY403508163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health