Provider Demographics
NPI:1225127194
Name:GRUIS, KIRSTEN L (MD)
Entity Type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:L
Last Name:GRUIS
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 1:90 PRESIDENTIAL PLZ
Mailing Address - Street 2:4TH FLOOR - NEUROLOGY
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13202-2240
Mailing Address - Country:US
Mailing Address - Phone:315-464-4243
Mailing Address - Fax:315-464-5350
Practice Address - Street 1:90 PRESIDENTIAL PLZ
Practice Address - Street 2:4TH FLOOR - NEUROLOGY
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13202-2240
Practice Address - Country:US
Practice Address - Phone:315-464-4243
Practice Address - Fax:315-464-5350
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2638562084N0008X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0008XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeuromuscular Medicine
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03423003Medicaid
NYJ400065597Medicare PIN