Provider Demographics
NPI:1619923067
Name:GRIGORYAN, GALINA (MD)
Entity Type:Individual
Prefix:DR
First Name:GALINA
Middle Name:
Last Name:GRIGORYAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 AMSTERDAM AVE
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-5402
Mailing Address - Country:US
Mailing Address - Phone:201-220-5317
Mailing Address - Fax:
Practice Address - Street 1:192 PROSPECT AVENUE
Practice Address - Street 2:FACULTY PRACTICE OFFICE
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601
Practice Address - Country:US
Practice Address - Phone:201-880-4620
Practice Address - Fax:201-880-0701
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-26
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07111800207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJH25680Medicare UPIN
NJ042821Medicare ID - Type Unspecified