Provider Demographics
NPI:1659589083
Name:METROPOLITAN SPECIALTY PHYSICIANS
Entity Type:Organization
Organization Name:METROPOLITAN SPECIALTY PHYSICIANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:GRANATO
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:718-388-1600
Mailing Address - Street 1:PO BOX 30282
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10087-0282
Mailing Address - Country:US
Mailing Address - Phone:718-388-1600
Mailing Address - Fax:718-388-1551
Practice Address - Street 1:4046 75TH ST
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-1012
Practice Address - Country:US
Practice Address - Phone:718-388-1600
Practice Address - Fax:718-388-1551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2013-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty
No2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY08199Medicare PIN
NYA100000766Medicare PIN