Provider Demographics
NPI:1083159495
Name:GRIGORY RASIN LLC
Entity Type:Organization
Organization Name:GRIGORY RASIN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GRIGORY
Authorized Official - Middle Name:S
Authorized Official - Last Name:RASIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:908-686-4145
Mailing Address - Street 1:2143 MORRIS AVE STE 108
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-6021
Mailing Address - Country:US
Mailing Address - Phone:908-686-4145
Mailing Address - Fax:908-851-2128
Practice Address - Street 1:2143 MORRIS AVE STE 108
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-6021
Practice Address - Country:US
Practice Address - Phone:908-686-4145
Practice Address - Fax:908-851-2128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-21
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA042275002084P0800X
NJ25MA065563002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ023269Medicare PIN