Provider Demographics
NPI:1497908339
Name:PHILIP GRUSKIN MD INC
Entity Type:Organization
Organization Name:PHILIP GRUSKIN MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES/SEC'Y
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:
Authorized Official - Last Name:GRUSKIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-541-4485
Mailing Address - Street 1:3015 VIA BUENA
Mailing Address - Street 2:
Mailing Address - City:PALOS VERDES ESTATES
Mailing Address - State:CA
Mailing Address - Zip Code:90274-4419
Mailing Address - Country:US
Mailing Address - Phone:310-541-4485
Mailing Address - Fax:310-541-4485
Practice Address - Street 1:3015 VIA BUENA
Practice Address - Street 2:
Practice Address - City:PALOS VERDES ESTATES
Practice Address - State:CA
Practice Address - Zip Code:90274-4419
Practice Address - Country:US
Practice Address - Phone:310-541-4485
Practice Address - Fax:310-541-4485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-23
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC31451207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty