Provider Demographics
NPI:1588716849
Name:GRUEN, PETER HENRY (MD, FAPA, PC)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:HENRY
Last Name:GRUEN
Suffix:
Gender:M
Credentials:MD, FAPA, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 E 77TH ST APT B
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-1700
Mailing Address - Country:US
Mailing Address - Phone:212-249-2720
Mailing Address - Fax:
Practice Address - Street 1:18 E 77TH ST APT B
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-1700
Practice Address - Country:US
Practice Address - Phone:212-249-2720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1029602084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry