Provider Demographics
NPI:1598891475
Name:SAMUEL GRUBMAN M.D.,P.C.
Entity Type:Organization
Organization Name:SAMUEL GRUBMAN M.D.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GRUBMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD,PC
Authorized Official - Phone:212-616-4122
Mailing Address - Street 1:70 E 10TH ST
Mailing Address - Street 2:APT 12K
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-5102
Mailing Address - Country:US
Mailing Address - Phone:212-616-4122
Mailing Address - Fax:212-616-4124
Practice Address - Street 1:154 W 14TH ST
Practice Address - Street 2:4TH FL
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-7307
Practice Address - Country:US
Practice Address - Phone:212-616-4122
Practice Address - Fax:212-616-4124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY162736207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01586736Medicaid
NYA61694Medicare UPIN