Organization
GRENVILLE MEDICAL PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BERNARD KABAKOW MD (OWNER)
(917) 576-4481
Entity
Organization
Contact information
Practice address
308A E 15TH ST, NEW YORK, NY 10003-4001
(212) 674-4455
Mailing address
308A E 15TH ST, NEW YORK, NY 10003-4001
(212) 674-4455
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
075329
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00100936
—
NY
Enumeration date
07/27/2006
Last updated
12/28/2007
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