Provider Demographics
NPI:1720093420
Name:ADVANCED FAMILY MEDICAL CARE PC
Entity Type:Organization
Organization Name:ADVANCED FAMILY MEDICAL CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SVETLANA
Authorized Official - Middle Name:
Authorized Official - Last Name:GROSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD DO
Authorized Official - Phone:718-253-9110
Mailing Address - Street 1:900 AVENUE H APT 1M
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-2834
Mailing Address - Country:US
Mailing Address - Phone:718-253-9110
Mailing Address - Fax:718-253-0767
Practice Address - Street 1:900 AVENUE H APT 1M
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-2834
Practice Address - Country:US
Practice Address - Phone:718-253-9110
Practice Address - Fax:718-253-0767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY219277207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWHA171Medicare ID - Type Unspecified