Provider Demographics
NPI:1760050728
Name:GRUNTFEST, ERNEST
Entity Type:Individual
Prefix:MR
First Name:ERNEST
Middle Name:
Last Name:GRUNTFEST
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 COMMODORE DR
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10309-3975
Mailing Address - Country:US
Mailing Address - Phone:917-603-2684
Mailing Address - Fax:201-625-2684
Practice Address - Street 1:55 COMMODORE DR
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10309-3975
Practice Address - Country:US
Practice Address - Phone:917-603-2684
Practice Address - Fax:201-625-2684
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-16
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator