Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 307458 | NY |
NPI | 1023481777 |
---|---|
Provider Name | Dr. Grigoriy Fooks |
First Address | Bronx, NY 10458-1000 |
Second Address | Bronx, NY 10453-4303 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/11/2015 |
Last Update Date | 15/03/2016 |