Provider Demographics
NPI:1891813424
Name:GRINBERG, DIANA (CGP, RPH)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:GRINBERG
Suffix:
Gender:F
Credentials:CGP, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MATAWAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07747-3125
Mailing Address - Country:US
Mailing Address - Phone:732-441-1223
Mailing Address - Fax:
Practice Address - Street 1:155 MAIN ST
Practice Address - Street 2:
Practice Address - City:MATAWAN
Practice Address - State:NJ
Practice Address - Zip Code:07747-3125
Practice Address - Country:US
Practice Address - Phone:732-111-1111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02780200183500000X, 1835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835G0303XPharmacy Service ProvidersPharmacistGeriatric