Provider Demographics
NPI:1275813404
Name:GROGAN, ANN MARIE (NP)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:MARIE
Last Name:GROGAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 VARICK STREET
Mailing Address - Street 2:PROJECT RENEWAL
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10014
Mailing Address - Country:US
Mailing Address - Phone:646-489-2430
Mailing Address - Fax:
Practice Address - Street 1:200 VARICK ST
Practice Address - Street 2:PROJECT RENEWAL
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10014-4810
Practice Address - Country:US
Practice Address - Phone:646-489-2430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-19
Last Update Date:2017-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY573440163W00000X
NY401413363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse