Provider Demographics
NPI:1548553217
Name:GRUDNIKOFF, EUGENE (MD)
Entity type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:
Last Name:GRUDNIKOFF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:400 SUNRISE HWY
Mailing Address - Street 2:SOUTH OAKS HOSPITAL - CH203
Mailing Address - City:AMITYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11701-2508
Mailing Address - Country:US
Mailing Address - Phone:631-608-5205
Mailing Address - Fax:631-608-4112
Practice Address - Street 1:400 SUNRISE HWY
Practice Address - Street 2:SOUTH OAKS HOSPITAL - CH203
Practice Address - City:AMITYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11701-2508
Practice Address - Country:US
Practice Address - Phone:631-608-5205
Practice Address - Fax:631-608-4112
Is Sole Proprietor?:No
Enumeration Date:2011-05-27
Last Update Date:2014-08-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY2626382084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry