Provider Demographics
NPI:1831444819
Name:MIKHAIL GRZHIBEK, M.D., P.C.
Entity type:Organization
Organization Name:MIKHAIL GRZHIBEK, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MIKHAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:GRZHIBEK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-750-2937
Mailing Address - Street 1:285 SILLS RD BLDG 4
Mailing Address - Street 2:SUITE D
Mailing Address - City:EAST PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-4869
Mailing Address - Country:US
Mailing Address - Phone:631-654-1800
Mailing Address - Fax:631-240-9181
Practice Address - Street 1:285 SILLS RD BLDG 4
Practice Address - Street 2: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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-17
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY239339261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care