Active NPI
Candice Grogan
- Specialist
- Ronkonkoma, NY
National Provider Identifier
1417622192
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- 1400608
- Practice address
- 90 Air Park Dr
Ronkonkoma, NY 11779-7360 - Phone
- (631) 580-4001
- NPI assigned
- Aug 13, 2021
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 1400608 | NY | Primary |
Addresses
Primary practice location
90 Air Park Dr
Ronkonkoma, NY 11779-7360
Mailing address
90 Air Park Dr
Ronkonkoma, NY 11779-7360
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1400608 | NY | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1628812800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1628812800000",
"number": "1417622192",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "90 AIR PARK DR",
"city": "RONKONKOMA",
"state": "NY",
"postal_code": "117797360"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "90 AIR PARK DR",
"city": "RONKONKOMA",
"state": "NY",
"postal_code": "117797360",
"telephone_number": "631-580-4001"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GROGAN",
"first_name": "CANDICE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-08-13",
"last_updated": "2021-08-13",
"certification_date": "2021-08-13",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "NY",
"license": "1400608",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ronkonkoma, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.