Provider Demographics
NPI:1639335250
Name:BROOKLYN OSTEOPATHIC, PC
Entity Type:Organization
Organization Name:BROOKLYN OSTEOPATHIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:GRADY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:917-685-0187
Mailing Address - Street 1:33 PROSPECT PARK SW
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-5939
Mailing Address - Country:US
Mailing Address - Phone:917-685-0187
Mailing Address - Fax:
Practice Address - Street 1:33 PROSPECT PARK SW
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-5939
Practice Address - Country:US
Practice Address - Phone:917-685-0187
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-04
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY219244207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty