Provider Demographics
NPI:1972999282
Name:GROTELL, LAUREN (MD)
Entity type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:
Last Name:GROTELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LAUREN
Other - Middle Name:
Other - Last Name:BERLINER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:128 FALMOUTH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-3006
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:128 FALMOUTH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-3006
Practice Address - Country:US
Practice Address - Phone:917-734-5626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-13
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY300656207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty