Provider Demographics
NPI:1457320426
Name:GRENDELL, JAMES HENRY (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:HENRY
Last Name:GRENDELL
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 1:222 STATION PLAZA NORTH
Mailing Address - Street 2:SUITE 428
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-3819
Mailing Address - Country:US
Mailing Address - Phone:516-663-2066
Mailing Address - Fax:516-663-4655
Practice Address - Street 1:222 STATION PLAZA NORTH
Practice Address - Street 2:SUITE 428
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-3819
Practice Address - Country:US
Practice Address - Phone:516-663-2066
Practice Address - Fax:516-663-4655
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY196808207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01586658Medicaid
A44689Medicare UPIN
33J341Medicare ID - Type Unspecified