Healthcare Provider Details

I. General information

NPI: 1689960395
Provider Name (Legal Business Name): LORENA GRULLON-FIGUEROA MD, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2011
Last Update Date: 06/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1262 BOSTON RD
BRONX NY
10462
US

IV. Provider business mailing address

1262 BOSTON RD
BRONX NY
10456-3602
US

V. Phone/Fax

Practice location:
  • Phone: 347-349-5888
  • Fax:
Mailing address:
  • Phone: 347-349-5888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number251831
License Number StateNY

VIII. Authorized Official

Name: DR. LORENA GRULLON-FIGUEROA
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 347-349-5888