Healthcare Provider Details

I. General information

NPI: 1972792661
Provider Name (Legal Business Name): LARRY F. GRIFFITH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2007
Last Update Date: 09/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 DEKALB AVE 8TH FLOOR
BROOKLYN NY
11201-5425
US

IV. Provider business mailing address

1385 SWEETMAN AVE
ELMONT NY
11003-3245
US

V. Phone/Fax

Practice location:
  • Phone: 718-250-8320
  • Fax: 718-250-6080
Mailing address:
  • Phone: 718-250-8320
  • Fax: 718-250-6080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number232507
License Number StateNY

VIII. Authorized Official

Name: DR. LARRY F GRIFFITH
Title or Position: MEDICAL DORTOR
Credential: MD
Phone: 917-714-1933