MEDICARE: MS. LAURETTA GRZEGORCZYK 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	172740	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

General Provider Information

NPI Number	:	1346385424
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LAURETTA GRZEGORCZYK M.D.

Provider Business Mailing Address
First Line	:	2015 BATH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11214-4857
Country	:	US
Telephone Number	:	718-266-3399
Fax Number	:	718-266-2773

Provider Business Practice Location Address
First Line	:	2015 BATH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11214-4857
Country	:	US
Telephone Number	:	718-266-3399
Fax Number	:	718-266-2773

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

Provider Enumeration Date	:	02/20/2007
Last Update Date	:	07/08/2007

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