Provider Demographics
NPI:1750409447
Name:GRUBER, CAROLYN JOY (PA)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:JOY
Last Name:GRUBER
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:414 ALBEMARLE RD
Mailing Address - Street 2:6F
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11218-2355
Mailing Address - Country:US
Mailing Address - Phone:347-350-9850
Mailing Address - Fax:
Practice Address - Street 1:NYU SCHOOL OF MEDICINE
Practice Address - Street 2:550 FIRST AVENUE, NB 8-WEST-41
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016
Practice Address - Country:US
Practice Address - Phone:212-562-3583
Practice Address - Fax:212-263-7806
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY6462363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant