| Promed Preferred VA Professional Corporation | |
|
1314 54th St Brooklyn NY 11219-4219 | |
| (615) 499-3165 | |
| Not Available |
| Full Name | Promed Preferred VA Professional Corporation |
|---|---|
| Speciality | Internal Medicine |
| Location | 1314 54th St, Brooklyn, New York |
| Authorized Official Name and Position | Lev Grinman (PRESIDENT) |
| Authorized Official Contact | 6154993165 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Promed Preferred VA Professional Corporation 329 S Oyster Bay Rd # 2059 Plainview NY 11803-3301 | Promed Preferred VA Professional Corporation 1314 54th St Brooklyn NY 11219-4219 Ph: (615) 499-3165 |
| NPI Number | 1376343194 |
|---|---|
| Provider Enumeration Date | 03/19/2025 |
| Last Update Date | 06/27/2025 |
| Certification Date | 06/27/2025 |
| Medicare PECOS PAC ID | 3072002013 |
|---|---|
| Medicare Enrollment ID | O20251029003655 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376343194 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (NU) | Primary |
| Provider Name | Graciela Rodriguez Santos |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285913772 PECOS PAC ID: 7911169784 Enrollment ID: I20160301002474 |
| Provider Name | Lydia Maxine Wheeler |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811539067 PECOS PAC ID: 4587075650 Enrollment ID: I20201120000683 |
| Provider Name | Megan Ryan-riffle |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356957534 PECOS PAC ID: 8022420876 Enrollment ID: I20260109002956 |
| Provider Name | Laura Lee Minor |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1831812502 PECOS PAC ID: 2567956949 Enrollment ID: I20260114001529 |
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