Provider Demographics
NPI:1215377767
Name:GRUNDMANN, NICOLAS KRASOVEC (MD)
Entity Type:Individual
Prefix:
First Name:NICOLAS
Middle Name:KRASOVEC
Last Name:GRUNDMANN
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 1:26 COURT ST STE 1901
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11242-1119
Mailing Address - Country:US
Mailing Address - Phone:347-547-3258
Mailing Address - Fax:
Practice Address - Street 1:26 COURT ST STE 1901
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11242-1119
Practice Address - Country:US
Practice Address - Phone:347-547-3258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-28
Last Update Date:2018-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY285543207P00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine