Provider Demographics
NPI:1942249412
Name:GRANADY, LYNELLE C (MD)
Entity Type:Individual
Prefix:DR
First Name:LYNELLE
Middle Name:C
Last Name:GRANADY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:660 WHITE PLAINS RD FL 4
Mailing Address - Street 2:
Mailing Address - City:TARRYTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10591-5139
Mailing Address - Country:US
Mailing Address - Phone:914-984-2546
Mailing Address - Fax:
Practice Address - Street 1:150 E 58TH ST FL 34
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10155-3499
Practice Address - Country:US
Practice Address - Phone:212-722-5570
Practice Address - Fax:212-722-4573
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY206021207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY54123X0402Medicare PIN
NYG04532Medicare UPIN
NY541231Medicare ID - Type Unspecified