Provider Demographics
NPI:1053381715
Name:GREWAL, PERMINDER S (MD)
Entity type:Individual
Prefix:DR
First Name:PERMINDER
Middle Name:S
Last Name:GREWAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 GRAND ST
Mailing Address - Street 2:FL 3
Mailing Address - City:WARWICK
Mailing Address - State:NY
Mailing Address - Zip Code:10990-1035
Mailing Address - Country:US
Mailing Address - Phone:845-942-1001
Mailing Address - Fax:845-987-5979
Practice Address - Street 1:12 LIBERTY SQUARE MALL
Practice Address - Street 2:
Practice Address - City:STONY POINT
Practice Address - State:NY
Practice Address - Zip Code:10980-2400
Practice Address - Country:US
Practice Address - Phone:845-942-1001
Practice Address - Fax:845-942-1431
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY157708174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY54D492OtherEMPIRE BC WEST NYACK
NY733693OtherCONNECTICARE
NY114459OtherWELLCARE
NY157708OtherHIP
NY6008462OtherMVP/TACONIC IPA
NY000000014459OtherGHI HMO
NY01010388Medicaid
NY0043771OtherAETNA HMO
NY13-3693126OtherTAX ID #
NY4061280OtherAETNA PPO
NYN33226OtherHEALTHNET
NY157708-9OtherWORKERS COMP
NY54D491OtherEMPIRE BC STONY POINT
NYRP034OtherOXFORD
NY110019900OtherRAILROAD MEDICARE
NY000000014459OtherGHI HMO
NYRP034OtherOXFORD
NY54D492OtherEMPIRE BC WEST NYACK