Healthcare Provider Details

I. General information

NPI: 1043483449
Provider Name (Legal Business Name): ISLAND HEIGHTS PEDIATRICS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2008
Last Update Date: 04/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8014 13TH AVE
BROOKLYN NY
11228-3002
US

IV. Provider business mailing address

8014 13 AVENUE
BROOKLYN NY
11228-3002
US

V. Phone/Fax

Practice location:
  • Phone: 718-238-1000
  • Fax: 718-238-1802
Mailing address:
  • Phone: 718-238-1000
  • Fax: 718-238-1802

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. ANNMARIE GRIGOLETTO
Title or Position: PRESIDENT
Credential: M.D.
Phone: 718-238-1000