Provider Demographics
NPI:1033516430
Name:GRINBERG, STANISLAV (PHD)
Entity Type:Individual
Prefix:
First Name:STANISLAV
Middle Name:
Last Name:GRINBERG
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2279 CONEY ISLAND AVE
Mailing Address - Street 2:SUITE 3B
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-3337
Mailing Address - Country:US
Mailing Address - Phone:718-998-9899
Mailing Address - Fax:718-998-9896
Practice Address - Street 1:2279 CONEY ISLAND AVE
Practice Address - Street 2:SUITE 3B
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-3337
Practice Address - Country:US
Practice Address - Phone:718-998-9899
Practice Address - Fax:718-998-9896
Is Sole Proprietor?:No
Enumeration Date:2014-12-01
Last Update Date:2014-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYGRINS3247ZC0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247ZC0005XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyClinical Laboratory Director, Non-physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYGRINS3OtherCQ CODE