Provider Demographics
NPI:1396071445
Name:GRAND MEDICAL BALDWIN
Entity type:Organization
Organization Name:GRAND MEDICAL BALDWIN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:SCOTTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-882-3101
Mailing Address - Street 1:PO BOX 624
Mailing Address - Street 2:
Mailing Address - City:BALDWIN
Mailing Address - State:NY
Mailing Address - Zip Code:11510-0572
Mailing Address - Country:US
Mailing Address - Phone:516-442-1488
Mailing Address - Fax:516-280-7660
Practice Address - Street 1:1651 GRAND AVE
Practice Address - Street 2:
Practice Address - City:BALDWIN
Practice Address - State:NY
Practice Address - Zip Code:11510
Practice Address - Country:US
Practice Address - Phone:516-442-1488
Practice Address - Fax:516-280-7660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-26
Last Update Date:2009-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty