Individual provider Active NPI

Adrian J. Gruszko, M.D.

  • Pediatrics Physician
  • Poughkeepsie, NY
National Provider Identifier
1255392379
Registry record updated Jul 13, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
207746 Issued in NY
Practice address
301 Manchester Rd
Suite 105
Poughkeepsie, NY 12603-2587
Phone
(845) 452-1700
Fax
(845) 452-1752
NPI assigned
Mar 29, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 207746 NY Primary

Addresses

Primary practice location

301 Manchester Rd
Suite 105
Poughkeepsie, NY 12603-2587

Mailing address

301 Manchester Rd
Suite 105
Poughkeepsie, NY 12603-2587
Phone (845) 452-1700

Other identifiers 1

IdentifierTypeStateIssuer
01762665MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110512000053 NY Practitioner - Pediatric Medicine 2466638275 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
207746NYMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Sun River Health Inc Current Accepting new patients
Sun River Health Inc. CurrentSince Feb 13, 2011 Accepting new patients

Locations

3360 Route 343
Amenia, NY 12501
Phone (845) 373-9006

1037 Main St
Peekskill, NY 10566
Phone (914) 734-8800

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1143590400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1657670400000",
    "number": "1255392379",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 MANCHESTER RD",
            "address_2": "SUITE 105",
            "city": "POUGHKEEPSIE",
            "state": "NY",
            "postal_code": "126032587",
            "telephone_number": "845-452-1700",
            "fax_number": "845-452-1752"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 MANCHESTER RD",
            "address_2": "SUITE 105",
            "city": "POUGHKEEPSIE",
            "state": "NY",
            "postal_code": "126032587",
            "telephone_number": "845-452-1700",
            "fax_number": "845-452-1752"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRUSZKO",
        "first_name": "ADRIAN",
        "middle_name": "J.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-29",
        "last_updated": "2022-07-13",
        "certification_date": "2022-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NY",
            "license": "207746",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01762665",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Poughkeepsie, NY

Sources for this page

Verify at the official NPI Registry.