MEDICARE: MARIA GROHOVSKI M.D

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	210629	NY

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
2	176AM1	OTHER	NY	EMPIRE BCBS

General Provider Information

NPI Number	:	1275635963
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIA GROHOVSKI M.D

Provider Business Mailing Address
First Line	:	17 HARMON ST
Second Line	:
City	:	LONG BEACH
State	:	NY
Zip	:	11561-2707
Country	:	US
Telephone Number	:	718-336-3500
Fax Number	:	718-336-2737

Provider Business Practice Location Address
First Line	:	1811 QUENTIN RD
Second Line	:	#1H
City	:	BROOKLYN
State	:	NY
Zip	:	11229-1343
Country	:	US
Telephone Number	:	718-336-3500
Fax Number	:	718-336-2737

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/02/2006
Last Update Date	:	07/26/2008

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