MEDICARE: PROXI MEDICAL PC

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	261QU0200X	Urgent Care Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184000853
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROXI MEDICAL PC

Provider Business Mailing Address
First Line	:	1665 BEDFORD AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11225-2023
Country	:	US
Telephone Number	:	718-756-4000
Fax Number	:	718-756-4003

Provider Business Practice Location Address
First Line	:	1665 BEDFORD AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11225-2023
Country	:	US
Telephone Number	:	718-756-4000
Fax Number	:	718-756-4003

Authorized Official
Title or Position	:	AUTHORIZED REP/OWNER
Name	:	ANNA GRINKO
Credential	:	MD
Telephone Number	:	718-756-4000

Provider Enumeration Date	:	08/05/2015
Last Update Date	:	10/12/2015

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Directions to “PROXI MEDICAL PC ” Practice Location

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