Healthcare Provider Details

I. General information

NPI: 1962225417
Provider Name (Legal Business Name): INCLUSIVE HEALTHCARE PROFESSIONAL MEDICINE NY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2024
Last Update Date: 11/04/2024
Certification Date: 10/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

329 S OYSTER BAY RD STE 2059
PLAINVIEW NY
11803-3301
US

IV. Provider business mailing address

329 S OYSTER BAY RD STE 2059
PLAINVIEW NY
11803-3301
US

V. Phone/Fax

Practice location:
  • Phone: 615-499-3165
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: LEV GRINMAN
Title or Position: PRESIDENT
Credential: MD
Phone: 615-499-3165