Provider Demographics
NPI:1063405496
Name:GRAYSON, STEPHEN (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:GRAYSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 E MAIN ST
Mailing Address - Street 2:NORTHERN WESTCHESTER HOSPITAL, MEDICAL AFFAIRS
Mailing Address - City:MOUNT KISCO
Mailing Address - State:NY
Mailing Address - Zip Code:10549-3417
Mailing Address - Country:US
Mailing Address - Phone:914-666-1200
Mailing Address - Fax:914-666-1965
Practice Address - Street 1:400 E MAIN ST
Practice Address - Street 2:NORTHERN WESTCHESTER HOSPITAL EMERGENCY DEPT
Practice Address - City:MOUNT KISCO
Practice Address - State:NY
Practice Address - Zip Code:10549-3417
Practice Address - Country:US
Practice Address - Phone:914-666-1254
Practice Address - Fax:914-666-1268
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY133867207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
4147732OtherMVP HEALTHPLAN ID #
4702133OtherGHI PPO PROVIDER ID
0511100000034OtherFIDELISCARE PROVIDER ID#
2665341OtherAETNA HMO PROVIDER ID#
10112151-D815OtherCDPHP PROV & GRP PIN
P1974829OtherOXFORD HEALTHPLAN ID #
000000093405OtherGHI HMO PROVIDER ID#
2H7971OtherEMPIRE BCBS PROVIDER PIN#
5C7511OtherHEALTHNET PROVIDER ID#
77599226OtherAETNA PPO PROVIDER ID#
5C7511OtherHEALTHNET PROVIDER ID#
NY38H432Medicare PIN
NY38H4373781Medicare PIN