Provider Demographics
NPI:1538421011
Name:GROYSMAN, INNA
Entity type:Individual
Prefix:
First Name:INNA
Middle Name:
Last Name:GROYSMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3111 BRIGHTON 1ST PL APT 3H
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-7634
Mailing Address - Country:US
Mailing Address - Phone:134-752-9892
Mailing Address - Fax:
Practice Address - Street 1:3111 BRIGHTON 1ST PL APT 3H
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-7634
Practice Address - Country:US
Practice Address - Phone:347-529-8929
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-11
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1186014174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist