Provider Demographics
NPI:1679501928
Name:GRANATO, ROBERTO E (MD)
Entity Type:Individual
Prefix:
First Name:ROBERTO
Middle Name:E
Last Name:GRANATO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 MARCUS AVE
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11042-1113
Mailing Address - Country:US
Mailing Address - Phone:516-622-6000
Mailing Address - Fax:
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:718-335-1437
Practice Address - Fax:718-899-1846
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2015-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY172297208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01618299Medicaid
NY08199SMedicare PIN
NY01618299Medicaid
NYB58677Medicare UPIN