Provider Demographics
NPI:1245585900
Name:GRINSHPUN, NINA G (DPT)
Entity Type:Individual
Prefix:
First Name:NINA
Middle Name:G
Last Name:GRINSHPUN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 CHANGEBRIDGE RD
Mailing Address - Street 2:SUITE F
Mailing Address - City:MONTVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07045-8947
Mailing Address - Country:US
Mailing Address - Phone:973-917-3134
Mailing Address - Fax:973-917-3138
Practice Address - Street 1:2 CHANGEBRIDGE RD
Practice Address - Street 2:SUITE F
Practice Address - City:MONTVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07045-8947
Practice Address - Country:US
Practice Address - Phone:973-917-3134
Practice Address - Fax:973-917-3138
Is Sole Proprietor?:No
Enumeration Date:2012-07-18
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1467617795Medicare NSC