Provider Demographics
NPI:1174586515
Name:GRUSKIN, ALAN KEITH (DO)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:KEITH
Last Name:GRUSKIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 NW 13TH ST STE 104
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486-2350
Mailing Address - Country:US
Mailing Address - Phone:561-394-3587
Mailing Address - Fax:561-394-4530
Practice Address - Street 1:900 NW 13TH ST STE 104
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486-2350
Practice Address - Country:US
Practice Address - Phone:561-394-3587
Practice Address - Fax:561-394-4530
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-07
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS48322081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL82801Medicare ID - Type Unspecified