Provider Demographics
NPI:1851498505
Name:GRINGUT, LUBA VEADA (MD)
Entity Type:Individual
Prefix:DR
First Name:LUBA
Middle Name:VEADA
Last Name:GRINGUT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LYUBOV
Other - Middle Name:
Other - Last Name:DIKAREVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:661 BARCLAY AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312
Mailing Address - Country:US
Mailing Address - Phone:718-984-2800
Mailing Address - Fax:718-984-3600
Practice Address - Street 1:661 BARCLAY AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312
Practice Address - Country:US
Practice Address - Phone:718-984-2800
Practice Address - Fax:718-984-3600
Is Sole Proprietor?:No
Enumeration Date:2006-09-17
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY214499207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02000388Medicaid
H07977Medicare UPIN
NY02000388Medicaid