MEDICARE: PROMED PREFERRED IA PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1144196973
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROMED PREFERRED IA PLLC

Provider Business Mailing Address
First Line	:	329 S OYSTER BAY RD # 2059
Second Line	:
City	:	PLAINVIEW
State	:	NY
Zip	:	11803-3301
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	142 MAIN ST
Second Line	:
City	:	BLOOMINGBURG
State	:	NY
Zip	:	12721-4611
Country	:	US
Telephone Number	:	615-499-3165
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	LEV GRINMAN
Credential	:
Telephone Number	:	615-499-3165

Provider Enumeration Date	:	10/17/2025
Last Update Date	:	03/05/2026

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