Provider Demographics
NPI:1720357817
Name:GREUNER MEDICAL PC
Entity Type:Organization
Organization Name:GREUNER MEDICAL PC
Other - Org Name:NYC SURGICAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:GREUNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:888-286-6600
Mailing Address - Street 1:PO BOX 28124
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10087-8124
Mailing Address - Country:US
Mailing Address - Phone:888-286-6600
Mailing Address - Fax:800-565-9415
Practice Address - Street 1:14 E 60TH ST
Practice Address - Street 2:SUITE 501
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-1006
Practice Address - Country:US
Practice Address - Phone:888-286-6600
Practice Address - Fax:800-565-9415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-20
Last Update Date:2017-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207L00000X, 208600000X
NY247175208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY247175OtherSTATE LICENSE NUMBER