1720024136 NPI number — DR. STEVEN JEFFREY GRUBER M.D.

Table of content: DR. STEVEN JEFFREY GRUBER M.D. (NPI 1720024136)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720024136 NPI number — DR. STEVEN JEFFREY GRUBER M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GRUBER
Provider First Name:
STEVEN
Provider Middle Name:
JEFFREY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1720024136
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/18/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P O BOX 95000-2150
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19195-2150
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-420-4003
Provider Business Mailing Address Fax Number:
212-420-4043

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10 UNION SQUARE EAST
Provider Second Line Business Practice Location Address:
BETH ISRAEL MEDICAL CENTERBAIRD HALLNEPHROLOGY DIVISION
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10003-3805
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-420-4003
Provider Business Practice Location Address Fax Number:
212-420-4043
Provider Enumeration Date:
06/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RN0300X , with the licence number:  178227 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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