Healthcare Provider Details

I. General information

NPI: 1578766333
Provider Name (Legal Business Name): GREL OBS OBGYN PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2007
Last Update Date: 09/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1766 E 12TH ST
BROOKLYN NY
11229-1014
US

IV. Provider business mailing address

1766 E 12TH ST
BROOKLYN NY
11229-1014
US

V. Phone/Fax

Practice location:
  • Phone: 718-743-0505
  • Fax: 718-339-0760
Mailing address:
  • Phone: 718-743-0505
  • Fax: 718-339-0760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. GREGORY SUIFRIN
Title or Position: OWNER
Credential: M.D.
Phone: 718-743-0505