Provider Demographics
NPI:1215195318
Name:GRUNIN, AVI J (MD)
Entity Type:Individual
Prefix:DR
First Name:AVI
Middle Name:J
Last Name:GRUNIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1 LYONS ST
Mailing Address - Street 2:
Mailing Address - City:DEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02026-5599
Mailing Address - Country:US
Mailing Address - Phone:617-654-7111
Mailing Address - Fax:781-461-9349
Practice Address - Street 1:1 LYONS ST
Practice Address - Street 2:
Practice Address - City:DEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02026-5599
Practice Address - Country:US
Practice Address - Phone:617-654-7111
Practice Address - Fax:781-461-9349
Is Sole Proprietor?:No
Enumeration Date:2008-05-27
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY2444212080P0214X
MA2431142080S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080S0010XAllopathic & Osteopathic PhysiciansPediatricsSports Medicine
No2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric Pulmonology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0022573Medicare PIN