Provider Demographics
NPI:1164984498
Name:GRACE MROZ NP IN PSYCHIATRY PLLC
Entity Type:Organization
Organization Name:GRACE MROZ NP IN PSYCHIATRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:
Authorized Official - Last Name:MROZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-730-7503
Mailing Address - Street 1:450 WAVERLY AVE
Mailing Address - Street 2:BUILDING 4 SUITE 11
Mailing Address - City:PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772
Mailing Address - Country:US
Mailing Address - Phone:631-730-7503
Mailing Address - Fax:631-307-9422
Practice Address - Street 1:450 WAVERLY AVE
Practice Address - Street 2:BUILDING 4 SUITE 11
Practice Address - City:PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772
Practice Address - Country:US
Practice Address - Phone:631-730-7503
Practice Address - Fax:631-307-9422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-04
Last Update Date:2019-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty