National Provider Identifier Database

GRAND STREET MEDICAL PLLC
General Practice

A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions.

Contact Information

GRAND STREET MEDICAL PLLC
666 GRAND ST
BROOKLYN, NY  11211-4853
Phone: 718-963-0555
Fax: 718-963-4889
Website:
Specialty Taxonomy Code
* General Practice 208D00000X
Addiction Medicine 207QA0401X
Family Medicine 207Q00000X
Geriatric Medicine 207QG0300X
Geriatric Medicine 207RG0300X
Internal Medicine 207R00000X
Medical Oncology 207RX0202X
Physical Medicine & Rehabilitation 208100000X
Surgery 208600000X

* Indicates primary specialty

NPI Profile & details for GRAND STREET MEDICAL PLLC

NPI Number 1568485985
Legal business name
LBN		 GRAND STREET MEDICAL PLLC
Authorized official HEMA GANDHI - (ADMINISTRATION)
Entity Organization
Organization subpart No
Enumeration date 07/26/2006
Last updated 04/18/2012 - About 14 years ago
Sole proprietor1 Not specified
Identifiers
  • NY License #: 111281
  • NY Medicaid: 00199748
  • NY Medicaid: 03196274
  • NY Medicaid: WPPD41
  • Other: 12295130 CAQH
  • NY Other: 11128160NY 1199 NATIONAL BENEFIT
  • NY Other: GJ617239 GHI
  • NY Other: 0192659 GRAND STREET MEDICAL PC
  • NY Other: 55247 HIP

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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