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General NPI Number Information
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NPI Number | 1043232143
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Entity Type | Organization
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Legal Business Name | GRACE FAMILY MEDICAL PRACTICE PC
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Dates
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Enumeration Date | 07/25/2006
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Last Update Date | 01/09/2026
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Provider Practice Location Address
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Address Line | 1222 E 96TH ST 2ND FL
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City | BROOKLYN
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State | NY
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Zip | 11236-3903
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Country | US
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Telephone | 718-257-3355
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Fax | 718-257-4562
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Provider Business Mailing Address
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Address Line | 1222 E 96TH ST 2ND FLOOR
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City | BROOKLYN
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State | NY
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Zip | 11236-3903
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Country | US
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Telephone | 718-257-3355
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Fax | 718-257-4562
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Authorized Official
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Title or Position | MD
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Name | DR. BERNADETTE LIZINA SHERIDAN
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Credential | MD
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Telephone | 718-257-3355
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 173000000X
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Taxonomy Name | Legal Medicine
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License Number | 149698
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License Number State | NY
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