Provider Demographics
NPI:1659054187
Name:GRUBE, MARIE CARMEL
Entity Type:Individual
Prefix:MS
First Name:MARIE CARMEL
Middle Name:
Last Name:GRUBE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 ACKERMAN PL
Mailing Address - Street 2:
Mailing Address - City:NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10960-2106
Mailing Address - Country:US
Mailing Address - Phone:646-379-2742
Mailing Address - Fax:
Practice Address - Street 1:158 WEST 56TH STREET
Practice Address - Street 2:SUITE 1804
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019
Practice Address - Country:US
Practice Address - Phone:212-662-9200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-10
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY192211021405300000X
NY902106991405300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes405300000XOther Service ProvidersPrevention Professional