Healthcare Provider Details

I. General information

NPI: 1467218859
Provider Name (Legal Business Name): LEV GRINMAN MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2024
Last Update Date: 02/23/2024
Certification Date: 02/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 N BRAND BLVD # 25C
GLENDALE CA
91203-2347
US

IV. Provider business mailing address

4 LEGENDS CIR
MELVILLE NY
11747-5302
US

V. Phone/Fax

Practice location:
  • Phone: 310-926-2490
  • Fax:
Mailing address:
  • Phone: 844-776-6332
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State

VIII. Authorized Official

Name: LEV GRINMAN
Title or Position: OWNER
Credential: MD
Phone: 310-926-2490