Provider Demographics
NPI:1841217759
Name:GRUNBERG, ALLAN HERBERT (MD)
Entity Type:Individual
Prefix:
First Name:ALLAN
Middle Name:HERBERT
Last Name:GRUNBERG
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:PO BOX 305
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON DEPOT
Mailing Address - State:CT
Mailing Address - Zip Code:06794-0305
Mailing Address - Country:US
Mailing Address - Phone:860-868-1882
Mailing Address - Fax:
Practice Address - Street 1:40 HIFIELD DR
Practice Address - Street 2:
Practice Address - City:WASHINGTON DEPOT
Practice Address - State:CT
Practice Address - Zip Code:06794-1114
Practice Address - Country:US
Practice Address - Phone:860-868-1882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-16
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT040375207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTO45507Medicare UPIN