Provider Demographics
NPI:1801396148
Name:ESTI GROSSBERGER NP IN FAMILY HEALTH PLLC
Entity Type:Organization
Organization Name:ESTI GROSSBERGER NP IN FAMILY HEALTH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FNP
Authorized Official - Prefix:
Authorized Official - First Name:ESTI
Authorized Official - Middle Name:
Authorized Official - Last Name:GROSSBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-215-0745
Mailing Address - Street 1:4 GREG SIKORSKY DR
Mailing Address - Street 2:
Mailing Address - City:MONSEY
Mailing Address - State:NY
Mailing Address - Zip Code:10952-1240
Mailing Address - Country:US
Mailing Address - Phone:347-215-0745
Mailing Address - Fax:
Practice Address - Street 1:55 OLD TURNPIKE RD
Practice Address - Street 2:
Practice Address - City:NANUET
Practice Address - State:NY
Practice Address - Zip Code:10954
Practice Address - Country:US
Practice Address - Phone:347-215-0745
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-13
Last Update Date:2018-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00357548Medicaid