Provider Demographics
NPI:1700952124
Name:GRULLON, BELKYS (PA)
Entity Type:Individual
Prefix:MS
First Name:BELKYS
Middle Name:
Last Name:GRULLON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:7901 BROADWAY
Mailing Address - Street 2:ORTHOPEDIC SURGERY,D4-55
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-1329
Mailing Address - Country:US
Mailing Address - Phone:718-334-3376
Mailing Address - Fax:718-334-5057
Practice Address - Street 1:7901 BROADWAY
Practice Address - Street 2:ORTHOPEDIC SURGERY, D4-55
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-1329
Practice Address - Country:US
Practice Address - Phone:718-334-3376
Practice Address - Fax:718-334-5057
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY008486363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical