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NPI Code Detail

MEDICARE: MRS. ILONA GRIMBERG

MEDICARE:  MRS. ILONA  GRIMBERG
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
1156FX1800XOptician007492-1NY

General Provider Information

NPI Number : 1861646093
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. ILONA GRIMBERG
Provider Business Mailing Address
First Line : 6373 108TH ST
Second Line :
City : FOREST HILLS
State : NY
Zip : 11375-1607
Country : US
Telephone Number : 718-896-2020
Fax Number : 718-459-3490
Provider Business Practice Location Address
First Line : 6373 108TH ST
Second Line :
City : FOREST HILLS
State : NY
Zip : 11375-1607
Country : US
Telephone Number : 718-896-2020
Fax Number : 718-459-3490
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/14/2008
Last Update Date : 11/14/2008

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Directions to “ MRS. ILONA GRIMBERG ” Practice Location

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