Provider Demographics
NPI:1285882464
Name:GRUSHKO, AARON (RPA)
Entity type:Individual
Prefix:MR
First Name:AARON
Middle Name:
Last Name:GRUSHKO
Suffix:
Gender:M
Credentials:RPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 PENN ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11211-8322
Mailing Address - Country:US
Mailing Address - Phone:718-596-0963
Mailing Address - Fax:718-596-6498
Practice Address - Street 1:212 PENN ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11211-8322
Practice Address - Country:US
Practice Address - Phone:718-596-0963
Practice Address - Fax:718-596-6498
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-31
Last Update Date:2008-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000753363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01284404Medicaid