# GRAND STREET GASTROENTEROLOGY, INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1831259795
- **Authorized official:** STEPHANIE CLEARWATER (OFFICE MGR./ADMINISTRATOR)
- **Authorized official phone:** (845) 853-8106

## Contact information

- **Practice address:** 33 GRAND ST, KINGSTON, NY 12401-3933
- **Practice address phone:** (845) 853-8106
- **Practice address fax:** (845) 853-8093
- **Mailing address:** 33 GRAND ST, KINGSTON, NY 12401-3933
- **Mailing address phone:** (845) 338-2300
- **Mailing address fax:** (845) 338-9711

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | 5501209R | NY | Yes |

## Other

- **Enumeration date:** 12/11/2006
- **Last updated:** 05/20/2021