Individual
DR. CORITA REILLEY GRUDZEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
550 1ST AVE, NEW YORK, NY 10016-6402
(212) 263-3293
Mailing address
550 1ST AVE, NEW YORK, NY 10016-6402
(212) 263-3293
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
233941-1
NY
207P00000X
Emergency Medicine Physician
A91053
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000120752
GHI HMO PIN#
—
01
—
0170035
GHI PPO PIN #
—
01
—
070913000141
FIDELISCARE OF NY
—
01
—
10127536
CDPHP PIN #
—
01
—
1591896
AETNA HMO PIN #
—
01
—
3592Q1
EMPIRE BC BS
—
01
—
6007526
MVP HEALTHPLAN PIN #
—
01
—
6C5394
HEALTHNET PIN #
—
01
—
7243967
AETNA PPO #
—
Enumeration date
07/05/2007
Last updated
05/25/2022
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