Provider Demographics
NPI:1447351093
Name:GRUHN, THOMAS MICHAEL
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:MICHAEL
Last Name:GRUHN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:279 LARKFIELD RD
Mailing Address - Street 2:
Mailing Address - City:EAST NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11731-2415
Mailing Address - Country:US
Mailing Address - Phone:631-262-1370
Mailing Address - Fax:631-262-0415
Practice Address - Street 1:279 LARKFIELD RD
Practice Address - Street 2:
Practice Address - City:EAST NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11731-2415
Practice Address - Country:US
Practice Address - Phone:631-262-1370
Practice Address - Fax:631-262-0415
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012195208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY113578837Medicare ID - Type UnspecifiedPHYSICAL THERAPY OUT PATI