Healthcare Provider Details

I. General information

NPI: 1619923067
Provider Name (Legal Business Name): GALINA GRIGORYAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 05/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

192 PROSPECT AVENUE FACULTY PRACTICE OFFICE
HACKENSACK NJ
07601
US

IV. Provider business mailing address

516 AMSTERDAM AVE
RIDGEWOOD NJ
07450-5402
US

V. Phone/Fax

Practice location:
  • Phone: 201-880-4620
  • Fax: 201-880-0701
Mailing address:
  • Phone: 201-220-5317
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA07111800
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: