Provider Demographics
NPI:1194070151
Name:GROTSKY, IRA A (M ED SAS)
Entity type:Individual
Prefix:MR
First Name:IRA
Middle Name:A
Last Name:GROTSKY
Suffix:
Gender:M
Credentials:M ED SAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 OCEAN PKWY
Mailing Address - Street 2:APT.2B
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11218-3273
Mailing Address - Country:US
Mailing Address - Phone:718-877-3833
Mailing Address - Fax:
Practice Address - Street 1:235 OCEAN PKWY
Practice Address - Street 2:APT.2B
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11218-3273
Practice Address - Country:US
Practice Address - Phone:718-877-3833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-16
Last Update Date:2012-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist