Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 194368 | NY |
N | 207QA0401X | Family Doctor - Addiction Medicine | 194368 | NY |
NPI | 1528035805 |
---|---|
Provider Name | Dr. Cindy Celeste Grubin |
First Address | East Meadow, NY 11554-2912 |
Second Address | Fresh Meadows, NY 11366-1950 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/03/2006 |
Last Update Date | 28/12/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F88862 | (02) | NY |