Provider Demographics
NPI:1629033709
Name:GRZHIBEK, MIKHAIL (MD)
Entity type:Individual
Prefix:DR
First Name:MIKHAIL
Middle Name:
Last Name:GRZHIBEK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:285 SILLS RD
Mailing Address - Street 2:BUILDING 4, SUITE D
Mailing Address - City:EAST PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-4869
Mailing Address - Country:US
Mailing Address - Phone:917-750-2937
Mailing Address - Fax:
Practice Address - Street 1:285 SILLS RD
Practice Address - Street 2:BUILDING 4 SUITE D
Practice Address - City:EAST PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-4869
Practice Address - Country:US
Practice Address - Phone:631-654-1800
Practice Address - Fax:631-240-9181
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2015-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY239339207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
I58547Medicare UPIN
NY2479S1Medicare PIN