Provider Demographics
NPI:1184708794
Name:GROCHOWSKI, SABINA THERESA (MD)
Entity type:Individual
Prefix:DR
First Name:SABINA
Middle Name:THERESA
Last Name:GROCHOWSKI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:812 GRAMATAN AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10552-1048
Mailing Address - Country:US
Mailing Address - Phone:904-668-1678
Mailing Address - Fax:914-668-1678
Practice Address - Street 1:10440 QUEENS BLVD
Practice Address - Street 2:SUITE 1F
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-3658
Practice Address - Country:US
Practice Address - Phone:718-275-7088
Practice Address - Fax:718-275-0476
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY188186207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01444417Medicaid
F50086Medicare UPIN
00790Medicare ID - Type Unspecified