Healthcare Provider Details

I. General information

NPI: 1699084111
Provider Name (Legal Business Name): BETINA Y GRIGOROFF RNC, BSN, CCE, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2010
Last Update Date: 09/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 W 160TH ST SUITE 6E
NEW YORK NY
10032-5613
US

IV. Provider business mailing address

601 W 160TH ST SUITE 6E
NEW YORK NY
10032-5613
US

V. Phone/Fax

Practice location:
  • Phone: 212-928-3791
  • Fax:
Mailing address:
  • Phone: 212-928-3791
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number197-13965
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: