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Organization
GRAND STREET GASTROENTEROLOGY, INC.
Active
Organization
GRAND STREET GASTROENTEROLOGY, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHANIE CLEARWATER (OFFICE MGR./ADMINISTRATOR)
(845) 853-8106
Entity
Organization
Contact information
Practice address
33 GRAND ST, KINGSTON, NY 12401-3933
(845) 853-8106
(845) 853-8093
Mailing address
33 GRAND ST, KINGSTON, NY 12401-3933
(845) 338-2300
(845) 338-9711
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
5501209R
NY
Other
Enumeration date
12/11/2006
Last updated
05/20/2021
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