Basic Information
| Provider Information | |||||||||
| NPI: | 1871805523 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GRANT | ||||||||
| FirstName: | SCOTT | ||||||||
| MiddleName: | BRYAN | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D., M. BIOETHICS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 45 KRYSTAL DR | ||||||||
| Address2: | |||||||||
| City: | SOMERS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105893029 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2482594548 | ||||||||
| FaxNumber: | 8883729871 | ||||||||
| Practice Location | |||||||||
| Address1: | PUTNAM HOSPITAL CENTER - CAMARDA CARE CENTER | ||||||||
| Address2: | 672 STONELEIGH AVE | ||||||||
| City: | CARMEL | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105123923 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8452792000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2010 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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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 | 208600000X | 288213 | NY | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | I20150312001346 | 01 | NJ | MEDICARE PECOS | OTHER |