Provider Demographics
NPI:1275635963
Name:GROHOVSKI, MARIA (MD)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:GROHOVSKI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 HARMON ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-2707
Mailing Address - Country:US
Mailing Address - Phone:718-336-3500
Mailing Address - Fax:718-336-2737
Practice Address - Street 1:1811 QUENTIN RD
Practice Address - Street 2:#1H
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-1343
Practice Address - Country:US
Practice Address - Phone:718-336-3500
Practice Address - Fax:718-336-2737
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2008-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY210629207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01867394Medicaid
NY176AM1OtherEMPIRE BCBS
G75737Medicare UPIN
NYWEU351Medicare ID - Type UnspecifiedEMPIRE MEDICARE
NY06533GMedicare ID - Type UnspecifiedGHI MEDICARE