Provider Demographics
NPI:1639438963
Name:GRAYEVSKY, MARINA (OD)
Entity Type:Individual
Prefix:
First Name:MARINA
Middle Name:
Last Name:GRAYEVSKY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:393 AVENUE S APT 6B
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-2961
Mailing Address - Country:US
Mailing Address - Phone:718-646-9172
Mailing Address - Fax:
Practice Address - Street 1:711 BRIGHTWATER CT APT 2J
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-6609
Practice Address - Country:US
Practice Address - Phone:718-646-9172
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-07
Last Update Date:2019-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006699156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1215289525OtherNPI