DR. MARK GRUDMAN (NPI# 1750330049) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1750330049 |
| Entity Type | Individual |
| Full Name | DR. MARK GRUDMAN |
| Credential | M.D. |
| Practice Address |
129 Broadway Amityville NY 11701-2729 |
| Practice Telephone | 6315983434 |
| Practice Fax Number | 6315984723 |
| Mailing Telephone | 6315983434 |
| Mailing Fax Number | 6315984723 |
| Enumeration Date | 2006-05-06 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | X |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 174400000X | Specialist | 192167 | NY | Other Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NY | 01762176 | 05 |
| Street Address |
129 BROADWAY |
| City | AMITYVILLE |
| State | NY |
| Zip Code | 11701-2729 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831147511 | Mathew Thomas Chengot | Internal Medicine | 129 Broadway, Amityville, NY 11701-2729 | 2006-05-04 |
| 1578805917 | Vascular Corrections PC | Internal Medicine | 129 Broadway, Amityville, NY 11701-2729 | 2013-03-25 |
| 1295960094 | Thomas Mathew Chengot | Internal Medicine | 129 Broadway, Amityville, NY 11701 | 2009-05-21 |
| 1467626838 | Vijaykumar Shah Md P.C. | Internal Medicine | 129 Broadway, Amityville, NY 11701-2729 | 2008-04-16 |
| 1467670661 | Mathew T. Chengot Md PC | Specialist | 129 Broadway, Amityville, NY 11701-2729 | 2007-04-23 |
| 1568411353 | James A Colasacco | Specialist | 129 Broadway, Amityville, NY 11701-2729 | 2006-05-09 |
| 1215986500 | Bimalkumar P Brahmbhatt | Specialist | 129 Broadway, Amityville, NY 11701-2729 | 2006-05-06 |
| 1548219835 | Ralph F Caselnova II | Specialist | 129 Broadway, Amityville, NY 11701-2729 | 2006-05-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013427400 | Katya Cabrera | Licensed Practical Nurse | 8 Coolidge Ave, North Amityville, NY 11701 | 2017-10-11 |
| 1750800405 | Laura M Sabatino-jan | Nurse Practitioner | 65 S. Emerson Avenue, Amity Harbor, NY 11701 | 2017-09-13 |
| 1104355536 | Massapequa Center LLC | Skilled Nursing Facility | 101 Louden Ave., Amityville, NY 11701 | 2017-06-08 |
| 1588193874 | Allison Herzog | Specialist | 41 Terry Avenue, Amityville, NY 11701 | 2017-06-08 |
| 1962949677 | Sherlin Golbari | Physician Assistant | 317 Broadway Suite A, Amytyville, NY 11701 | 2017-01-20 |
| 1598129710 | Yoko Shiraiwa | Nurse Practitioner | 78 Ocean Avenue, Amityville, NY 11701 | 2016-04-13 |
| 1891158820 | Grace Ann Budde | Health Educator | 30 S Ireland Pl, Amityville, NY 11701 | 2016-03-29 |
| 1720445497 | Sabrina A Rahman | Pharmacist | 355 A Broadway, Amityville, NY 11701 | 2016-01-26 |
| 1902245335 | Darlene Marie Mccurty | Specialist | 125 Larsen Dr, Amityville, NY 11701 | 2013-06-19 |
| 1457613507 | Edria Parks | Specialist | 14 Wanser Pl, Amityville, NY 11701 | 2012-06-14 |
| Find all providers in zip 11701 | ||||
| Taxonomy Code | 174400000X |
| Grouping | Other Service Providers |
| Classification | Specialist |
| An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |
| Notes: Source: Expanded from Webster’s II New Riverside University Dictionary, Boston: Riverside Publishing Company, 1974. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588193874 | Allison Herzog | Specialist | 41 Terry Avenue, Amityville, NY 11701 | 2017-06-08 |
| 1669829735 | Amanda Agostino | Specialist | 15 Bingham Pl, Amityville, NY 11701-4218 | 2016-05-19 |
| 1033592167 | Todd Stillman | Specialist | 190 Merrick Rd, Unit 22, Amityville, NY 11701-3409 | 2015-07-07 |
| 1023407442 | Colleen Kretz | Specialist | 30 Franklin St, Amityville, NY 11701-3502 | 2015-01-22 |
| 1225452204 | Michelle Storz | Specialist | 26 Bedell Pl, Amityville, NY 11701-3302 | 2014-02-11 |
| 1558796474 | Kerry Ann Krohn | Specialist | 74 Barbara Ct, Amityville, NY 11701-1559 | 2013-09-10 |
| 1902245335 | Darlene Marie Mccurty | Specialist | 125 Larsen Dr, Amityville, NY 11701 | 2013-06-19 |
| 1790121218 | Priscilla Washington | Specialist | 22 Cedar Rd, Amityville, NY 11701-1302 | 2013-05-13 |
| 1417298456 | Dana Ferragamo | Specialist | 13 Barry Rd, Amityville, NY 11701-4001 | 2013-03-14 |
| 1093069585 | Rakiya Phillips | Specialist | 14 Lafayette Ave, Amityville, NY 11701-1725 | 2012-11-05 |
| Find all providers in AMITYVILLE | ||||
| City | AMITYVILLE |
| Zip Code | 11701 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.