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General NPI Number Information
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NPI Number | 1720897184
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Entity Type | Organization
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Legal Business Name | GRIGOL ADEISHVILI MEDICAL PLLC
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Dates
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Enumeration Date | 12/31/2024
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Last Update Date | 12/31/2024
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Provider Practice Location Address
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Address Line | 719 OCEAN VIEW AVE
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City | BROOKLYN
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State | NY
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Zip | 11235-6317
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Country | US
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Telephone | 347-491-3100
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Fax | 347-491-3200
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Provider Business Mailing Address
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Address Line | 719 OCEAN VIEW AVE
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City | BROOKLYN
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State | NY
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Zip | 11235-6317
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Country | US
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Telephone | 347-491-3100
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Fax | 347-491-3200
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Authorized Official
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Title or Position | OWNER
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Name | GRIGOL ADEISHVILI,
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Credential | MD
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Telephone | 347-491-3100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VX0000X
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Taxonomy Name | Obstetrics Physician
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License Number |
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License Number State |
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