Provider Demographics
NPI:1861441990
Name:GROYSMAN, GALINA
Entity Type:Individual
Prefix:
First Name:GALINA
Middle Name:
Last Name:GROYSMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2370 OCEAN AVE
Mailing Address - Street 2:APT 2F
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-3541
Mailing Address - Country:US
Mailing Address - Phone:917-553-3139
Mailing Address - Fax:
Practice Address - Street 1:2113 W 6TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-3756
Practice Address - Country:US
Practice Address - Phone:718-714-7272
Practice Address - Fax:718-714-0072
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX011086111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV06761Medicare UPIN
NYX02G21Medicare ID - Type Unspecified