Provider Demographics
NPI:1376849679
Name:ALAN GRUSKIN DO PA
Entity Type:Organization
Organization Name:ALAN GRUSKIN DO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GRUSKIN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:954-722-6777
Mailing Address - Street 1:7401 N UNIVERSITY DR
Mailing Address - Street 2:SUITE 106
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-2979
Mailing Address - Country:US
Mailing Address - Phone:954-722-6777
Mailing Address - Fax:954-722-6405
Practice Address - Street 1:7401 N UNIVERSITY DR
Practice Address - Street 2:SUITE 106
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-2979
Practice Address - Country:US
Practice Address - Phone:954-722-6777
Practice Address - Fax:954-722-6405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-03
Last Update Date:2011-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS4832208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD60735Medicare UPIN
FL82801Medicare PIN