Healthcare Provider Details

I. General information

NPI: 1922184290
Provider Name (Legal Business Name): MAX MEDICAL, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2006
Last Update Date: 06/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3049 OCEAN PKWY SUITE 300
BROOKLYN NY
11235-8302
US

IV. Provider business mailing address

3049 OCEAN PKWY SUITE 300
BROOKLYN NY
11235-8302
US

V. Phone/Fax

Practice location:
  • Phone: 718-615-3000
  • Fax: 718-332-2458
Mailing address:
  • Phone: 718-615-3000
  • Fax: 718-332-2458

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number159537
License Number StateNY

VIII. Authorized Official

Name: DR. GRIGORY S. POGREBINSKY
Title or Position: PRESIDENT
Credential: M.D.
Phone: 718-615-3000