Provider Demographics
NPI:1306075197
Name:GROSSBERG, YONINA RONI (PA)
Entity type:Individual
Prefix:MRS
First Name:YONINA
Middle Name:RONI
Last Name:GROSSBERG
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:1819 E 16TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-2910
Mailing Address - Country:US
Mailing Address - Phone:212-342-3484
Mailing Address - Fax:212-305-7021
Practice Address - Street 1:1819 E 16TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-2910
Practice Address - Country:US
Practice Address - Phone:212-342-3484
Practice Address - Fax:212-305-7021
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-14
Last Update Date:2009-07-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY002745-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant