Provider Demographics
NPI:1144497033
Name:GREWAL, KANWARPAUL S (D O)
Entity type:Individual
Prefix:MR
First Name:KANWARPAUL
Middle Name:S
Last Name:GREWAL
Suffix:
Gender:M
Credentials:D O
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 MERRICK AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554-1580
Mailing Address - Country:US
Mailing Address - Phone:516-743-9450
Mailing Address - Fax:516-743-9451
Practice Address - Street 1:30 MERRICK AVE STE 103
Practice Address - Street 2:
Practice Address - City:EAST MEADOW
Practice Address - State:NY
Practice Address - Zip Code:11554-1580
Practice Address - Country:US
Practice Address - Phone:516-743-9450
Practice Address - Fax:516-743-9451
Is Sole Proprietor?:No
Enumeration Date:2008-05-11
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY256297207X00000X, 207XX0004X, 207XX0801X, 207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle Surgery
No207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Trauma
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03918421Medicaid