Grand Street Gastroenterology, Inc.

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

5501209R Issued in NY

Legal business name

GRAND STREET GASTROENTEROLOGY, INC.

Practice address

33 Grand St
Kingston, NY 12401-3933

Phone

(845) 853-8106

Fax

(845) 853-8093

NPI assigned

Dec 11, 2006

Organization subpart

No

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

Authorized official

Name

Stephanie Clearwater

Title

Office MGR./Administrator

Phone

(845) 853-8106

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Listed as

Grand Street Gastroenterology IncCCN 33C0001079

Medicare certification status

ActiveFrom the Provider of Services file

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Hal N Buch, MD

  • Gastroenterology Physician
  • Kingston, NY
  • NPI 1780649574
  NPD

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

{
    "created_epoch": "1165795200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1621468800000",
    "number": "1831259795",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "33 GRAND ST",
            "city": "KINGSTON",
            "state": "NY",
            "postal_code": "124013933",
            "telephone_number": "845-338-2300",
            "fax_number": "845-338-9711"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "33 GRAND ST",
            "city": "KINGSTON",
            "state": "NY",
            "postal_code": "124013933",
            "telephone_number": "845-853-8106",
            "fax_number": "845-853-8093"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRAND STREET GASTROENTEROLOGY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-11",
        "last_updated": "2021-05-20",
        "certification_date": "2021-05-20",
        "status": "A",
        "authorized_official_last_name": "CLEARWATER",
        "authorized_official_first_name": "STEPHANIE",
        "authorized_official_title_or_position": "OFFICE MGR./ADMINISTRATOR",
        "authorized_official_telephone_number": "845-853-8106"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "NY",
            "license": "5501209R",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02523619",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Bradley L Gorfein, LMSW
• Vincent D Gorman
• Howard Paul Gottlieb, M.D.
• Barbara Sue Graff, LCSW-R
• Hannah Rose Grajko, LMSW
• Louis T Granirer, D.C.
• John H. Grant, LCSW-R
• Elizabeth A. Gray, OTD, MSOTR/L
• Pearl Edith Graziano, LPN
• Erik Grazier

• Ambulatory Surgical Clinic/Center in Kingston, NY
• Providers in Kingston, NY by specialty
• Ambulatory Surgical Clinic/Center in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.