Provider Demographics
NPI:1871673335
Name:GRIGORESCU, BOGDAN ANDREI (MD)
Entity Type:Individual
Prefix:
First Name:BOGDAN
Middle Name:ANDREI
Last Name:GRIGORESCU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 HICKSVILLE RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:BETHPAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11714-3471
Mailing Address - Country:US
Mailing Address - Phone:516-576-6106
Mailing Address - Fax:516-576-5801
Practice Address - Street 1:120 MINEOLA BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-4064
Practice Address - Country:US
Practice Address - Phone:516-663-3010
Practice Address - Fax:516-663-3026
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY236243207V00000X, 207VF0040X
MEMD19085207V00000X, 207VF0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyFemale Pelvic Medicine and Reconstructive Surgery
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY002616801Medicaid
NYA400103340Medicare PIN
ME002616801Medicare PIN
4N2437061Medicare PIN
ME002616802Medicare PIN
LA4N243Medicare PIN
NYG400007149Medicare PIN
MEP01046684Medicare PIN
MS07405847Medicaid
NY02993566OtherMEDICAID GROUP
MEP01079453Medicare PIN