Provider Demographics
NPI:1558659458
Name:GRINBERG, YULIYA (M ED)
Entity Type:Individual
Prefix:
First Name:YULIYA
Middle Name:
Last Name:GRINBERG
Suffix:
Gender:F
Credentials:M ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:226 SLATER BLVD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-3241
Mailing Address - Country:US
Mailing Address - Phone:718-705-0303
Mailing Address - Fax:718-705-0303
Practice Address - Street 1:226 SLATER BLVD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305-3241
Practice Address - Country:US
Practice Address - Phone:718-705-0303
Practice Address - Fax:718-705-0303
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-13
Last Update Date:2011-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY496346111, 496345111174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist