Individual
SUSAN GROVER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
N.P.P., C.S
Contact information
Practice address
1050 HALLOCK AVE., SUITE 4, PORT JEFFERSON STATION, NY 11776
(631) 886-1194
(631) 929-3039
Mailing address
658 SOUND AVE., F11, CALVERTON, NY 11933-1049
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
F400636-1
NY
Other
Enumeration date
02/20/2007
Last updated
07/08/2007
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