Healthcare Provider Details

I. General information

NPI: 1841544913
Provider Name (Legal Business Name): KARIN GRINBAUM DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/29/2012
Last Update Date: 10/10/2024
Certification Date: 10/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 E 88TH ST APT 1D
NEW YORK NY
10128-2217
US

IV. Provider business mailing address

160 E 88TH ST APT 1D
NEW YORK NY
10128-2217
US

V. Phone/Fax

Practice location:
  • Phone: 212-777-6177
  • Fax: 212-560-5444
Mailing address:
  • Phone: 212-777-6177
  • Fax: 212-560-5444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number056434-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: