Healthcare Provider Details

I. General information

NPI: 1669150942
Provider Name (Legal Business Name): MEGAN ELIZABETH GROGAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2023
Last Update Date: 07/29/2024
Certification Date: 07/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37 UPLAND DR
FLORIDA NY
10921-1233
US

IV. Provider business mailing address

1901 1ST AVE
NEW YORK NY
10029-7494
US

V. Phone/Fax

Practice location:
  • Phone: 646-872-6213
  • Fax:
Mailing address:
  • Phone: 212-423-6262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number404973
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: