MEDICARE: TATYANA GRINCHENKO DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RR0500X	Rheumatology Physician	235641	NY
2	207RR0500X	Rheumatology Physician	MB082529	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770627713
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TATYANA GRINCHENKO DO

Provider Business Mailing Address
First Line	:	363 STURBRIDGE RD
Second Line	:
City	:	WYCKOFF
State	:	NJ
Zip	:	07481-1562
Country	:	US
Telephone Number	:	917-449-6890
Fax Number	:	888-502-1596

Provider Business Practice Location Address
First Line	:	506 HAMBURG TPKE STE 201
Second Line	:
City	:	WAYNE
State	:	NJ
Zip	:	07470-2069
Country	:	US
Telephone Number	:	201-282-8356
Fax Number	:	888-502-1596

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/15/2007
Last Update Date	:	11/04/2016

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