Healthcare Provider Details

I. General information

NPI: 1346163268
Provider Name (Legal Business Name): BREANNA C GRUSNICK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2571 47TH ST
ASTORIA NY
11103-1108
US

IV. Provider business mailing address

123 W 13TH ST # 706
NEW YORK NY
10011-7801
US

V. Phone/Fax

Practice location:
  • Phone: 929-277-1253
  • Fax:
Mailing address:
  • Phone: 929-277-1253
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: