Provider Demographics
NPI:1982683249
Name:IRA E GRONOWITZ DDS PC
Entity type:Organization
Organization Name:IRA E GRONOWITZ DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:IRA
Authorized Official - Middle Name:E
Authorized Official - Last Name:GRONOWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-373-5000
Mailing Address - Street 1:8502 BAY PKWY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-4104
Mailing Address - Country:US
Mailing Address - Phone:718-373-5000
Mailing Address - Fax:718-372-6213
Practice Address - Street 1:8502 BAY PKWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214-4104
Practice Address - Country:US
Practice Address - Phone:718-373-5000
Practice Address - Fax:718-372-6213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
027244122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02151504Medicaid