Active NPI
Grigory Jacob Valdberg, M.D.
- Primary Care Clinic/Center
- Brooklyn, NY
National Provider Identifier
1790846046
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Primary Care Clinic/Center
- License
- 202572
- Practice address
- 1410 W 3Rd St
Brooklyn, NY 11204-4101 - Phone
- (718) 837-1031
- Fax
- (718) 837-1671
- NPI assigned
- Dec 12, 2006
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Primary Care Clinic/Center | 261QP2300X | 202572 | NY | Primary |
Addresses
Primary practice location
1410 W 3Rd St
Brooklyn, NY 11204-4101
Mailing address
1410 W 3Rd St
Brooklyn, NY 11204-4101
Phone (718) 837-1031
Other identifiers 16
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000000050434 | Other | NY | GHI HMO |
| 0B7301 | Other | NY | EMPIRE |
| 2699905 | Other | NY | GHI |
| PC2348 | Other | NY | CENTER CARE |
| 0P555P | Other | NY | HIP |
| 5251450 | Other | NY | AETNA |
| 26P3881 | Other | NY | PRESBYTERIAN |
| 202572 | Other | NY | LICENSE |
| BK0214503 | Other | NY | AMERICHOICE |
| 2C8442 | Other | NY | NELTH NET |
| 5026928 | Other | NY | CIGNA |
| 01648975 | Medicaid | NY | |
| 12-01328 | Other | NY | UHC |
| 137072 | Other | NY | WELL CARE |
| P1046880 | Other | NY | OXFORD |
| 202572-C79 | Other | NY | HEALTH FIRST |
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
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 202572 | NY | MD | Primary Care Clinic/Center |
Networks
- Healthfirst Medicare Network H1722
- Healthfirst Medicare Network H3359
- Healthfirst Medicare Network H5989
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1165881600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1790846046",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1410 W 3RD ST",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112044101",
"telephone_number": "718-837-1031",
"fax_number": "718-837-1671"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1410 W 3RD ST",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112044101",
"telephone_number": "718-837-1031",
"fax_number": "718-837-1671"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VALDBERG",
"first_name": "GRIGORY",
"middle_name": "JACOB",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-12-12",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "261QP2300X",
"taxonomy_group": "",
"desc": "Clinic/Center, Primary Care",
"state": "NY",
"license": "202572",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GHI HMO",
"identifier": "000000050434",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "EMPIRE",
"identifier": "0B7301",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GHI",
"identifier": "2699905",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CENTER CARE",
"identifier": "PC2348",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HIP",
"identifier": "0P555P",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "5251450",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PRESBYTERIAN",
"identifier": "26P3881",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSE",
"identifier": "202572",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AMERICHOICE",
"identifier": "BK0214503",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NELTH NET",
"identifier": "2C8442",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA",
"identifier": "5026928",
"state": "NY"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "01648975",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UHC",
"identifier": "12-01328",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WELL CARE",
"identifier": "137072",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OXFORD",
"identifier": "P1046880",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTH FIRST",
"identifier": "202572-C79",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Brooklyn, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.