| Doctor Name: | RANDALL D GRANT |
| NPI Number: | 1528370624 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | D.O. |
| License Number: | 257745 |
| Business Practice Address: | 4422 3rd Ave Bronx, NY - 104572545 |
| Business Phone Number: | 7189609000 |
| Business Fax Number: | |
| Mailing Address: | 4422 3rd Ave, BRONX |
| State: | NY |
| Postal Code: | 104572545 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 07/06/2010 |
| NPI Last Update Date: | 04/06/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 257745 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NY |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |