Provider Demographics
NPI:1689960395
Name:LORENA GRULLON-FIGUEROA MD, PLLC
Entity Type:Organization
Organization Name:LORENA GRULLON-FIGUEROA MD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LORENA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRULLON-FIGUEROA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:347-349-5888
Mailing Address - Street 1:1262 BOSTON RD
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10456-3602
Mailing Address - Country:US
Mailing Address - Phone:347-349-5888
Mailing Address - Fax:
Practice Address - Street 1:1262 BOSTON RD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10462
Practice Address - Country:US
Practice Address - Phone:347-349-5888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-21
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY251831261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03161057Medicaid