Provider Demographics
NPI:1437322203
Name:GRUNSTEIN, ARLENE RATANASIT (MD)
Entity Type:Individual
Prefix:DR
First Name:ARLENE
Middle Name:RATANASIT
Last Name:GRUNSTEIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ARLENE
Other - Middle Name:
Other - Last Name:RATANASIT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:800 IRVING AVENUE
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210
Mailing Address - Country:US
Mailing Address - Phone:315-425-4400
Mailing Address - Fax:315-425-4380
Practice Address - Street 1:800 IRVING AVENUE
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210
Practice Address - Country:US
Practice Address - Phone:315-425-4400
Practice Address - Fax:315-425-4380
Is Sole Proprietor?:No
Enumeration Date:2008-04-11
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA200348207W00000X
FLME104027207W00000X
NYMD274813207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL145C7OtherBC/BS
FL001070300Medicaid
FL145C7OtherBC/BS