Basic Information
| Provider Information | |||||||||
| NPI: | 1417031915 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GRUMET | ||||||||
| FirstName: | GERALD | ||||||||
| MiddleName: | WARREN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 73 THACKERY ROAD | ||||||||
| Address2: | |||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146103358 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5854422874 | ||||||||
| FaxNumber: | 5859225715 | ||||||||
| Practice Location | |||||||||
| Address1: | 73 THACKERY ROAD | ||||||||
| Address2: | |||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146103358 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5854422874 | ||||||||
| FaxNumber: | 5859225715 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/24/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 2084P0800X | 60926441 | NY | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 00433812 | 05 | NY | MEDICAID |