Promed Preferred PA 5 Professional Corporation
Internal Medicine in Brooklyn, NY. Organization (NPI-2).
NPI number1053200410
StatusActive
Last updated in NPPESJul 1, 2025
Details
- NPI
- 1053200410
- Entity type
- Organization (NPI-2)
- Legal business name
- Promed Preferred PA 5 Professional Corporation
- Organization subpart
- No
- Enumeration date
- Jul 1, 2025
- Certification date
- Jul 1, 2025
- Last updated
- Jul 1, 2025
Medicare and OIG
- Medicare enrolled (PECOS)
- Yes · PART B SUPPLIER - CLINIC/GROUP PRACTICE
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207R00000X | Internal Medicine | – | – | Yes |
Practice location
1314 54th StBrooklyn, NY 11219-4219
Phone 615-499-3165
Mailing address
329 S Oyster Bay Rd # 2059Plainview, NY 11803-3301
Authorized official
Lev Grinman
President
6154993165
Is something wrong?
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