Provider Demographics
NPI:1902839210
Name:GRODOFSKY, SARINA (APN)
Entity Type:Individual
Prefix:
First Name:SARINA
Middle Name:
Last Name:GRODOFSKY
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:184 LAUREL HILL RD
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN LAKES
Mailing Address - State:NJ
Mailing Address - Zip Code:07046-1217
Mailing Address - Country:US
Mailing Address - Phone:973-316-8657
Mailing Address - Fax:
Practice Address - Street 1:333 WASHINGTON AVE N
Practice Address - Street 2:SUITE 5000
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55401-1377
Practice Address - Country:US
Practice Address - Phone:612-767-1919
Practice Address - Fax:612-659-7101
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NN07337700363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily