Provider Demographics
NPI:1386614824
Name:GRIFFITH, LARRY FITZTERRENCE (MD)
Entity type:Individual
Prefix:MR
First Name:LARRY
Middle Name:FITZTERRENCE
Last Name:GRIFFITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1385 SWEETMAN AVE
Mailing Address - Street 2:
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003-3245
Mailing Address - Country:US
Mailing Address - Phone:718-250-8320
Mailing Address - Fax:718-250-6080
Practice Address - Street 1:121 DEKALB AVE
Practice Address - Street 2:8TH FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-5425
Practice Address - Country:US
Practice Address - Phone:718-250-8320
Practice Address - Fax:718-250-6080
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-26
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY232507208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02945339Medicaid
NY02945339Medicaid
I34062Medicare UPIN