Provider Demographics
NPI:1831464692
Name:GRUENFELD, JOHANNA LEIGH (RN)
Entity Type:Individual
Prefix:MS
First Name:JOHANNA
Middle Name:LEIGH
Last Name:GRUENFELD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 REGIS DR
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-1427
Mailing Address - Country:US
Mailing Address - Phone:718-697-3121
Mailing Address - Fax:
Practice Address - Street 1:280 REGIS DR
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-1427
Practice Address - Country:US
Practice Address - Phone:718-697-3121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-13
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY586417-1163WS0200X
NY586417163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
No163WH0200XNursing Service ProvidersRegistered NurseHome Health