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General NPI Number Information
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NPI Number | 1962473884
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Entity Type | Individual
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Provider Name | INESSA GRINBLAT M.D.,
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Gender | Female
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Dates
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Enumeration Date | 01/30/2006
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Last Update Date | 08/22/2018
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Provider Practice Location Address
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Address Line | 345 ROUTE 9 STE 8
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City | MANALAPAN
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State | NJ
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Zip | 07726-3240
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Country | US
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Telephone | 732-845-2200
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Fax | 732-845-0154
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Provider Business Mailing Address
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Address Line | 345 ROUTE 9 STE 8
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City | MANALAPAN
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State | NJ
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Zip | 07726-3240
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Country | US
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Telephone | 732-845-2200
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Fax | 732-845-0154
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 25 MA07690600
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License Number State | NJ
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