Provider Demographics
NPI:1528035805
Name:GRUBIN, CINDY CELESTE (DO)
Entity Type:Individual
Prefix:DR
First Name:CINDY
Middle Name:CELESTE
Last Name:GRUBIN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 LINDA DR
Mailing Address - Street 2:
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554-2912
Mailing Address - Country:US
Mailing Address - Phone:516-236-7778
Mailing Address - Fax:516-833-5843
Practice Address - Street 1:15905 UNION TPKE
Practice Address - Street 2:
Practice Address - City:FRESH MEADOWS
Practice Address - State:NY
Practice Address - Zip Code:11366-1950
Practice Address - Country:US
Practice Address - Phone:718-906-6700
Practice Address - Fax:718-380-9423
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-04
Last Update Date:2019-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY194368207QA0401X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF88862Medicare UPIN
NY5044B1Medicare ID - Type Unspecified
NY5044B1Medicare PIN