Active NPI
Paul L Grumback, PT LAC
- Physical Therapist
- Hicksville, NY
National Provider Identifier
1588653687
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 0059051
- Practice address
- 167 Acre LN
Hicksville, NY 11801-4442 - Phone
- (516) 932-3286
- Fax
- (516) 932-0669
- NPI assigned
- Oct 20, 2005
- Last updated
- Jul 13, 2026
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Acupuncturist | 171100000X | 0012381 | NY | |
| Physical Therapist | 225100000X | 0059051 | NY | Primary |
Addresses
Primary practice location
167 Acre LN
Hicksville, NY 11801-4442
Mailing address
167 Acre LN
Hicksville, NY 11801-4442
Phone (516) 932-3286
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2119754 | Other | NY | VUTRA |
| A497485 | Other | NY | OXFORD |
| 6601380 | Other | NY | GHI |
| 8080257 | Other | NY | UHC EMPIRE PLAN |
| 20137P | Other | NY | HIP |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0012381 | NY | MD | Acupuncturist |
| 0059051 | NY | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1129766400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1783900800000",
"number": "1588653687",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "167 ACRE LN",
"city": "HICKSVILLE",
"state": "NY",
"postal_code": "118014442",
"telephone_number": "516-932-3286",
"fax_number": "516-932-0669"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "167 ACRE LN",
"city": "HICKSVILLE",
"state": "NY",
"postal_code": "118014442",
"telephone_number": "516-932-3286",
"fax_number": "516-932-0669"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRUMBACK",
"first_name": "PAUL",
"middle_name": "L",
"name_prefix": "Mr.",
"credential": "PT LAC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-10-20",
"last_updated": "2026-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "171100000X",
"taxonomy_group": "",
"desc": "Acupuncturist",
"state": "NY",
"license": "0012381",
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NY",
"license": "0059051",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "VUTRA",
"identifier": "2119754",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OXFORD",
"identifier": "A497485",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GHI",
"identifier": "6601380",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UHC EMPIRE PLAN",
"identifier": "8080257",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HIP",
"identifier": "20137P",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Hicksville, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.