Individual
GRACE MROZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NPP
Contact information
Practice address
450 WAVERLY AVE, BUILDING 4 SUITE 11, PATCHOGUE, NY 11772-1555
(631) 730-7503
(631) 307-9422
Mailing address
450 WAVERLY AVE, BUILDING 4 SUITE 11, PATCHOGUE, NY 11772-1555
(631) 730-7503
(631) 307-9422
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
400668
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00659412
—
NY
Enumeration date
10/20/2006
Last updated
02/21/2018
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