Healthcare Provider Details

I. General information

NPI: 1114816402
Provider Name (Legal Business Name): BAY HARBOR PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2025
Last Update Date: 08/04/2025
Certification Date: 08/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 KANE CONCOURSE STE 504
BAY HARBOR ISLANDS FL
33154-2043
US

IV. Provider business mailing address

1111 KANE CONCOURSE STE 504
BAY HARBOR ISLANDS FL
33154-2043
US

V. Phone/Fax

Practice location:
  • Phone: 645-215-2600
  • Fax: 645-215-3200
Mailing address:
  • Phone: 645-215-2600
  • Fax: 645-215-3200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. EVAN P GRABOIS
Title or Position: OWNER
Credential: DO
Phone: 516-646-9156