Provider Demographics
NPI:1649382961
Name:GRANT, ARTHUR C (MD, PHD)
Entity Type:Individual
Prefix:
First Name:ARTHUR
Middle Name:C
Last Name:GRANT
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 CLARKSON AVE
Mailing Address - Street 2:BOX 1275
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203-2012
Mailing Address - Country:US
Mailing Address - Phone:718-270-2959
Mailing Address - Fax:718-270-4711
Practice Address - Street 1:450 CLARKSON AVE
Practice Address - Street 2:BOX 1275
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-2012
Practice Address - Country:US
Practice Address - Phone:718-270-2959
Practice Address - Fax:718-270-4711
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2361502084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02701637Medicaid
G96330Medicare UPIN
NY638N51Medicare ID - Type Unspecified