Provider Demographics
NPI:1750663159
Name:EYDELMAN-GRINN, VIKTORIA
Entity Type:Individual
Prefix:MRS
First Name:VIKTORIA
Middle Name:
Last Name:EYDELMAN-GRINN
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:VIKTORIA
Other - Middle Name:
Other - Last Name:EYDELMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:105 S MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10977-5474
Mailing Address - Country:US
Mailing Address - Phone:845-577-6000
Mailing Address - Fax:
Practice Address - Street 1:105 S MADISON AVE
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:NY
Practice Address - Zip Code:10977-5474
Practice Address - Country:US
Practice Address - Phone:845-577-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-13
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012038235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist