Basic Information
| Provider Information | |||||||||
| NPI: | 1063405496 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GRAYSON | ||||||||
| FirstName: | STEPHEN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 400 E MAIN ST | ||||||||
| Address2: | NORTHERN WESTCHESTER HOSPITAL, MEDICAL AFFAIRS | ||||||||
| City: | MOUNT KISCO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105493417 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9146661200 | ||||||||
| FaxNumber: | 9146661965 | ||||||||
| Practice Location | |||||||||
| Address1: | 400 E MAIN ST | ||||||||
| Address2: | NORTHERN WESTCHESTER HOSPITAL EMERGENCY DEPT | ||||||||
| City: | MOUNT KISCO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105493417 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9146661254 | ||||||||
| FaxNumber: | 9146661268 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2005 | ||||||||
| LastUpdateDate: | 01/22/2014 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 133867 | NY | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 4147732 | 01 | MVP HEALTHPLAN ID # | OTHER | 4702133 | 01 | GHI PPO PROVIDER ID | OTHER | 0511100000034 | 01 | FIDELISCARE PROVIDER ID# | OTHER | 2665341 | 01 | AETNA HMO PROVIDER ID# | OTHER | 10112151-D815 | 01 | CDPHP PROV & GRP PIN | OTHER | P1974829 | 01 | OXFORD HEALTHPLAN ID # | OTHER | 000000093405 | 01 | GHI HMO PROVIDER ID# | OTHER | 2H7971 | 01 | EMPIRE BCBS PROVIDER PIN# | OTHER | 5C7511 | 01 | HEALTHNET PROVIDER ID# | OTHER | 77599226 | 01 | AETNA PPO PROVIDER ID# | OTHER |