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NPI Code Detail

MEDICARE: MR. JEFF GRINKOVITCH MPT

MEDICARE: MR. JEFF GRINKOVITCH MPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12251X0800XOrthopedic Physical Therapist40QA01134300NJ

General Provider Information

NPI Number : 1447348990
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JEFF GRINKOVITCH MPT
Provider Business Mailing Address
First Line : 14 RUCKNER RD
Second Line :
City : WESTWOOD
State : NJ
Zip : 07675-3308
Country : US
Telephone Number : 201-594-1118
Fax Number :
Provider Business Practice Location Address
First Line : 125 WASHINGTON AVE
Second Line :
City : DUMONT
State : NJ
Zip : 07628-3066
Country : US
Telephone Number : 201-385-6272
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/10/2006
Last Update Date : 07/08/2007

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