Healthcare Provider Details

I. General information

NPI: 1386936367
Provider Name (Legal Business Name): SABRINA MARYLYNE GRATIA D.O
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2011
Last Update Date: 06/30/2020
Certification Date: 06/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

760 BROADWAY
BROOKLYN NY
11206-5383
US

IV. Provider business mailing address

760 BROADWAY DEPT OF
BROOKLYN NY
11206-5383
US

V. Phone/Fax

Practice location:
  • Phone: 187-963-8000
  • Fax:
Mailing address:
  • Phone: 187-963-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number279890
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number279890
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: