Provider Demographics
NPI:1508320342
Name:GRIGORY POGREBINSKY MD PA
Entity Type:Organization
Organization Name:GRIGORY POGREBINSKY MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GRIGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:POGREBINSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-502-0095
Mailing Address - Street 1:31 BOCA ROYALE BLVD
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:34223-1887
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12450 TAMIAMI TRL S UNIT E
Practice Address - Street 2:
Practice Address - City:NORTH PORT
Practice Address - State:FL
Practice Address - Zip Code:34287-1473
Practice Address - Country:US
Practice Address - Phone:917-502-0095
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-25
Last Update Date:2019-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty