Provider Demographics
NPI:1083816961
Name:GREBENYUK, FAYE-ROSE (DPM)
Entity Type:Individual
Prefix:DR
First Name:FAYE-ROSE
Middle Name:
Last Name:GREBENYUK
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1013 54TH ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-4970
Mailing Address - Country:US
Mailing Address - Phone:856-213-1645
Mailing Address - Fax:
Practice Address - Street 1:1013 54TH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-4970
Practice Address - Country:US
Practice Address - Phone:856-213-1645
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103301207213EP1101X, 213ES0000X, 213ES0103X, 213ES0131X, 213EP0504X, 213E00000X
NHEL07440213ES0103X, 213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports Medicine
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
No213EP0504XPodiatric Medicine & Surgery Service ProvidersPodiatristPublic Medicine
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist