Michael Grant

NPI #1073961538 in Bay Shore, New York

Provider Information

NPI Number: 1073961538
Entity Type: Individual
Name: Michael Grant
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Specialist
Enumeration Date: May 25, 2016
Last Updated: May 25, 2016

Practice Location

Address: 19 PINEBROOK PL
City: Bay Shore
State: New York
ZIP Code: 11706-4417
Phone: (631) 579-4267

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Specialist	174400000X	Primary

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