Provider Demographics
NPI:1679455083
Name:MODERN HEALTHCARE FAMILY HEALTH NP PLLC
Entity type:Organization
Organization Name:MODERN HEALTHCARE FAMILY HEALTH NP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GENESIS
Authorized Official - Middle Name:
Authorized Official - Last Name:GRULLON
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE PRACTITIONER
Authorized Official - Phone:917-405-5490
Mailing Address - Street 1:5800 ARLINGTON AVE APT 10W
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10471-1413
Mailing Address - Country:US
Mailing Address - Phone:917-405-5490
Mailing Address - Fax:
Practice Address - Street 1:5800 ARLINGTON AVE APT 10W
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10471-1413
Practice Address - Country:US
Practice Address - Phone:917-405-5490
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-24
Last Update Date:2025-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care