Rebecca Ellerin Grodko, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

061920 Issued in NY

Practice address

1901 1St Ave
New York, NY 10029-7494

Phone

(212) 423-6262

NPI assigned

Feb 25, 2020

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Rebecca Ellerin David Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1582588800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1667779200000",
    "number": "1114551587",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "596 S FOREST DR",
            "city": "TEANECK",
            "state": "NJ",
            "postal_code": "076662011",
            "telephone_number": "617-938-9189"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1901 1ST AVE",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100297494",
            "telephone_number": "212-423-6262"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRODKO",
        "first_name": "REBECCA",
        "middle_name": "ELLERIN",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-02-25",
        "last_updated": "2022-11-07",
        "certification_date": "2022-11-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NY",
            "license": null,
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "061920",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "REBECCA",
            "last_name": "DAVID",
            "middle_name": "ELLERIN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Carrie J Grochow
• Marcelina Maria Grochulska, M.S. CCC-SLP
• Lisa B Groden, PA-C
• Benn Grodin, LCSW
• Jessica Grodio-Polasko, DVM
• Ivy Sally Grodman, M.D
• Marc Dennis Grodman, M.D.
• Susan M Grodman, PHD
• Diane Grodney, PH.D., L.C.S.W.
• Mychal Shira Grodstein, RPA-C

• General Practice Dentistry in New York, NY
• Providers in New York, NY by specialty
• General Practice Dentistry in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.