Healthcare Provider Details

I. General information

NPI: 1275813404
Provider Name (Legal Business Name): ANN MARIE GROGAN N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2011
Last Update Date: 06/25/2025
Certification Date: 06/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

999 BLAKE AVE
BROOKLYN NY
11208-3535
US

IV. Provider business mailing address

60 MADISON AVE FL 5
NEW YORK NY
10010-1600
US

V. Phone/Fax

Practice location:
  • Phone: 718-277-8303
  • Fax: 718-277-4795
Mailing address:
  • Phone: 212-545-2400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number573440
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number401413
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: