Provider Demographics
NPI:1114928967
Name:GRINBERG, MANUEL (MD)
Entity Type:Individual
Prefix:
First Name:MANUEL
Middle Name:
Last Name:GRINBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 YAPHANK RD
Mailing Address - Street 2:STE 11B
Mailing Address - City:EAST PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-4800
Mailing Address - Country:US
Mailing Address - Phone:631-475-5051
Mailing Address - Fax:631-475-8268
Practice Address - Street 1:250 YAPHANK RD
Practice Address - Street 2:STE 11B
Practice Address - City:EAST PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-4800
Practice Address - Country:US
Practice Address - Phone:631-475-5051
Practice Address - Fax:631-475-8268
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2011-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY185806208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2434OtherVYTRA
NY2C0794OtherHEALTHNET
NY01251087-5Medicaid
NY1900179OtherUNITED HEALTHCARE
NY5610976015OtherCIGNA
NY93F811OtherEMPIRE BCBS
NY940046756OtherPHCS
NY340004365OtherRAILROAD MEDICARE
NY4283391OtherAETNA
NY5610976011OtherHEALTHCARE PARTNERS
NY219380POtherHIP
NYCS1073OtherOXFORD
NY100075OtherGHI
NY4283391OtherAETNA
NY5610976015OtherCIGNA