Provider Demographics
NPI:1619182649
Name:GRANEK, IRIS ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:IRIS
Middle Name:ANN
Last Name:GRANEK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:631 JAYNE BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11776-2947
Mailing Address - Country:US
Mailing Address - Phone:631-928-9396
Mailing Address - Fax:631-444-7525
Practice Address - Street 1:631 JAYNE BLVD
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON STATION
Practice Address - State:NY
Practice Address - Zip Code:11776-2947
Practice Address - Country:US
Practice Address - Phone:631-928-9396
Practice Address - Fax:631-444-7525
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-12
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1479632083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine