Active NPI
Jeff Myron Gruen
- Pediatrics Physician
- Suffern, NY
National Provider Identifier
1164227161
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 198448
- Practice address
- 400 Rella Blvd
Suffern, NY 10901-4241 - Phone
- (202) 281-6917
- NPI assigned
- Feb 14, 2025
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 198448 | NY | Primary |
Addresses
Primary practice location
400 Rella Blvd
Suffern, NY 10901-4241
Mailing address
400 Rella Blvd
Montebello, NY 10901-4241
Phone (202) 281-6917
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 198448 | NY | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1739491200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1739491200000",
"number": "1164227161",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "400 RELLA BLVD",
"city": "MONTEBELLO",
"state": "NY",
"postal_code": "109014241",
"telephone_number": "202-281-6917"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "400 RELLA BLVD",
"city": "SUFFERN",
"state": "NY",
"postal_code": "109014241",
"telephone_number": "202-281-6917"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRUEN",
"first_name": "JEFF",
"middle_name": "MYRON",
"name_prefix": "Dr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2025-02-14",
"last_updated": "2025-02-14",
"certification_date": "2025-02-14",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "NY",
"license": "198448",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Suffern, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.