1063405496 NPI number — STEPHEN GRAYSON MD

Table of content: STEPHEN GRAYSON MD (NPI 1063405496)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063405496 NPI number — STEPHEN GRAYSON MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GRAYSON
Provider First Name:
STEPHEN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1063405496
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/22/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
400 E MAIN ST
Provider Second Line Business Mailing Address:
NORTHERN WESTCHESTER HOSPITAL, MEDICAL AFFAIRS
Provider Business Mailing Address City Name:
MOUNT KISCO
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10549-3417
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-666-1200
Provider Business Mailing Address Fax Number:
914-666-1965

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
400 E MAIN ST
Provider Second Line Business Practice Location Address:
NORTHERN WESTCHESTER HOSPITAL EMERGENCY DEPT
Provider Business Practice Location Address City Name:
MOUNT KISCO
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10549-3417
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
914-666-1254
Provider Business Practice Location Address Fax Number:
914-666-1268
Provider Enumeration Date:
08/31/2005

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: 207P00000X , with the licence number:  133867 , 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)

  • Identifier: 4147732 . This is a "MVP HEALTHPLAN ID #" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4702133 . This is a "GHI PPO PROVIDER ID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0511100000034 . This is a "FIDELISCARE PROVIDER ID#" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2665341 . This is a "AETNA HMO PROVIDER ID#" identifier . This identifiers is of the category "OTHER".
  • Identifier: 10112151-D815 . This is a "CDPHP PROV & GRP PIN" identifier . This identifiers is of the category "OTHER".
  • Identifier: P1974829 . This is a "OXFORD HEALTHPLAN ID #" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000093405 . This is a "GHI HMO PROVIDER ID#" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2H7971 . This is a "EMPIRE BCBS PROVIDER PIN#" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5C7511 . This is a "HEALTHNET PROVIDER ID#" identifier . This identifiers is of the category "OTHER".
  • Identifier: 77599226 . This is a "AETNA PPO PROVIDER ID#" identifier . This identifiers is of the category "OTHER".




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