Provider Demographics
NPI:1760110316
Name:MEDVINSKY, GRACIE NICOLE (NP)
Entity Type:Individual
Prefix:
First Name:GRACIE
Middle Name:NICOLE
Last Name:MEDVINSKY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:GRACIE
Other - Middle Name:NICOLE
Other - Last Name:PEREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:1317 THIRD AVENUE
Mailing Address - Street 2:FLOOR 8
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-2962
Mailing Address - Country:US
Mailing Address - Phone:212-434-6400
Mailing Address - Fax:212-249-1269
Practice Address - Street 1:1317 THIRD AVENUE
Practice Address - Street 2:FLOOR 8
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-2962
Practice Address - Country:US
Practice Address - Phone:212-434-6400
Practice Address - Fax:212-249-1269
Is Sole Proprietor?:No
Enumeration Date:2022-08-11
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF383434363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics