Provider Demographics
NPI:1922452267
Name:YANA GRIGOREFF MD
Entity Type:Organization
Organization Name:YANA GRIGOREFF MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YANA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIGOREFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:409-256-4537
Mailing Address - Street 1:2201 PENNSYLVANIA AVE
Mailing Address - Street 2:APT 319
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19130-3513
Mailing Address - Country:US
Mailing Address - Phone:409-256-4537
Mailing Address - Fax:
Practice Address - Street 1:535 GRADYVILLE RD
Practice Address - Street 2:
Practice Address - City:NEWTOWN SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19073-2812
Practice Address - Country:US
Practice Address - Phone:409-256-4537
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-22
Last Update Date:2016-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation PractitionerGroup - Multi-Specialty