Individual
GLENN GRANUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
396 BROADWAY, MONTICELLO, NY 12701-1157
(845) 784-8080
Mailing address
PO BOX 573, FERNDALE, NY 12734-0573
(845) 807-9133
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
NY
Other
Enumeration date
11/17/2021
Last updated
11/17/2021
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