Provider Demographics
NPI:1699941781
Name:GRUSON, KONRAD IZUMI (MD)
Entity type:Individual
Prefix:DR
First Name:KONRAD
Middle Name:IZUMI
Last Name:GRUSON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1250 WATERS PL
Mailing Address - Street 2:11TH FLOOR
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-2720
Mailing Address - Country:US
Mailing Address - Phone:718-920-2060
Mailing Address - Fax:347-577-4428
Practice Address - Street 1:1250 WATERS PL
Practice Address - Street 2:11TH FLOOR
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-2720
Practice Address - Country:US
Practice Address - Phone:718-920-2060
Practice Address - Fax:347-577-4428
Is Sole Proprietor?:No
Enumeration Date:2008-05-07
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY229650207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery