Provider Demographics
NPI:1013917400
Name:GRINBERG, MIKHAIL (MD)
Entity Type:Individual
Prefix:
First Name:MIKHAIL
Middle Name:
Last Name:GRINBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1660 EAST 14 ST
Mailing Address - Street 2:STE 501
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229
Mailing Address - Country:US
Mailing Address - Phone:718-382-8500
Mailing Address - Fax:718-382-4648
Practice Address - Street 1:1660 EAST 14TH ST
Practice Address - Street 2:STE 501
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229
Practice Address - Country:US
Practice Address - Phone:718-382-8500
Practice Address - Fax:718-382-4648
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2009-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY172662207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01455710Medicaid
NYF31114Medicare UPIN
NY63K961Medicare ID - Type Unspecified
NY01455710Medicaid