Provider Demographics
NPI:1356345839
Name:GRUBER, ALAN HOWARD (MD)
Entity type:Individual
Prefix:
First Name:ALAN
Middle Name:HOWARD
Last Name:GRUBER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 CLINTON AVE S
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-2616
Mailing Address - Country:US
Mailing Address - Phone:585-244-6011
Mailing Address - Fax:585-244-0236
Practice Address - Street 1:2100 CLINTON AVE S
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-2616
Practice Address - Country:US
Practice Address - Phone:585-244-6011
Practice Address - Fax:585-244-0236
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2014-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY154919207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00962721Medicaid
NY1356345839OtherMVP
NYP010154919OtherBCBS
NY1073577961OtherEXCELLUS BCBS
NY180007722OtherRAILROAD MEDICARE
NY180007722OtherRAILROAD MEDICARE
NYB97926Medicare UPIN