Basic Information
| Provider Information | |||||||||
| NPI: | 1033111265 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GRIMSHAW, JR. | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | S. | ||||||||
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| Credential: | M.D., F.A.C.P. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 110 S BEDFORD RD | ||||||||
| Address2: | CARE MOUNT MEDICAL, PC | ||||||||
| City: | MOUNT KISCO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105493446 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9149623180 | ||||||||
| FaxNumber: | 9142421516 | ||||||||
| Practice Location | |||||||||
| Address1: | 3535 HILL BLVD STE R | ||||||||
| Address2: | CARE MOUNT MEDICAL PC | ||||||||
| City: | YORKTOWN HTS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105981209 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9149623180 | ||||||||
| FaxNumber: | 9142421516 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/01/2005 | ||||||||
| LastUpdateDate: | 11/11/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 143759-1 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 207RG0300X | 143759-1 | NY | N | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine |
ID Information
| ID | Type | State | Issuer | Description | 143759-9 CIM | 01 | NY | WORKERS COMP | OTHER | 00693274 | 05 | NY | MEDICAID |