Provider Demographics
NPI:1558755835
Name:GRIGORIY I LABUN
Entity Type:Organization
Organization Name:GRIGORIY I LABUN
Other - Org Name:MD PSYCHIATRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GRIGORIY
Authorized Official - Middle Name:I
Authorized Official - Last Name:LABUN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-631-8684
Mailing Address - Street 1:23 PEACH TREE LN
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02459-3123
Mailing Address - Country:US
Mailing Address - Phone:617-631-8684
Mailing Address - Fax:
Practice Address - Street 1:23 PEACH TREE LN
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02459-3123
Practice Address - Country:US
Practice Address - Phone:617-631-8684
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-24
Last Update Date:2015-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA229132084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty