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Organization
PGNM INC
Active
Organization
PGNM INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROBERT GRANT NIZNIK (CEO)
(786) 202-6338
Entity
Organization
Contact information
Practice address
9198 NW 8TH AVE, MIAMI, FL 33150-2004
(786) 202-6338
Mailing address
9198 NW 8TH AVE, MIAMI, FL 33150-2004
(786) 202-6338
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
—
—
174400000X
Specialist
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
2084A0401X
Addiction Medicine (Psychiatry & Neurology) Physician
—
—
Other
Enumeration date
05/20/2014
Last updated
05/21/2014
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