Active NPI
Marianne L Grandusky, PA
- Medical Physician Assistant
- New York, NY
National Provider Identifier
1225093289
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- 0075321
- Practice address
- 177 Fort Washington Ave
MHB 6GN 435
New York, NY 10032-3733 - Phone
- (212) 305-8932
- Fax
- (212) 305-3035
- NPI assigned
- Apr 20, 2006
- Last updated
- May 12, 2016
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | 0075321 | NY | Primary |
Addresses
Primary practice location
177 Fort Washington Ave
MHB 6GN 435
New York, NY 10032-3733
Mailing address
177 Fort Washington Ave
MHB 6GN 435
New York, NY 10032-3733
Phone (585) 766-5675
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0075321 | NY | MD | Medical Physician Assistant |
Interoperability endpoints
- mag9266@direct.nyp.org
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1145491200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1463011200000",
"number": "1225093289",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "177 FORT WASHINGTON AVE",
"address_2": "MHB 6GN 435",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100323733",
"telephone_number": "585-766-5675"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "177 FORT WASHINGTON AVE",
"address_2": "MHB 6GN 435",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100323733",
"telephone_number": "212-305-8932",
"fax_number": "212-305-3035"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRANDUSKY",
"first_name": "MARIANNE",
"middle_name": "L",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-04-20",
"last_updated": "2016-05-12",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "NY",
"license": "0075321",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in New York, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.