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General NPI Number Information
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NPI Number | 1396982021
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Entity Type | Individual
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Provider Name | SVETLANA GRINBERG
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Gender | Female
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Dates
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Enumeration Date | 01/16/2009
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Last Update Date | 01/16/2009
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Provider Practice Location Address
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Address Line | 2310 65TH ST 1ST FLOOR
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City | BROOKLYN
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State | NY
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Zip | 11204-4088
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Country | US
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Telephone | 718-743-7090
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Fax |
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Provider Business Mailing Address
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Address Line | 1041 ARCADIAN WAY
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City | FORT LEE
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State | NJ
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Zip | 07024-6349
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Country | US
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Telephone | 718-743-7090
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 008575
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License Number State | NY
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