Provider Demographics
NPI:1780244798
Name:KANWARPAUL S. GREWAL MEDICAL PLLC
Entity type:Organization
Organization Name:KANWARPAUL S. GREWAL MEDICAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KANWARPAUL
Authorized Official - Middle Name:S
Authorized Official - Last Name:GREWAL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:516-743-9450
Mailing Address - Street 1:30 MERRICK AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554-1580
Mailing Address - Country:US
Mailing Address - Phone:516-743-9450
Mailing Address - Fax:516-743-9451
Practice Address - Street 1:30 MERRICK AVE STE 103
Practice Address - Street 2:
Practice Address - City:EAST MEADOW
Practice Address - State:NY
Practice Address - Zip Code:11554-1580
Practice Address - Country:US
Practice Address - Phone:516-743-9450
Practice Address - Fax:516-743-9451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-20
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Multi-Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle SurgeryGroup - Multi-Specialty
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Multi-Specialty
No207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic TraumaGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03918421Medicaid