Provider Demographics
NPI:1356135842
Name:ANDERSON, GRANT OSCAR (FNP-BC)
Entity type:Individual
Prefix:
First Name:GRANT
Middle Name:OSCAR
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 W 28TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-4212
Mailing Address - Country:US
Mailing Address - Phone:212-545-2409
Mailing Address - Fax:212-463-8411
Practice Address - Street 1:511 WEST 157TH STREET
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-5058
Practice Address - Country:US
Practice Address - Phone:212-781-7979
Practice Address - Fax:212-781-7963
Is Sole Proprietor?:No
Enumeration Date:2025-04-08
Last Update Date:2025-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF357143-01363LF0000X
NY939125-01163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice