Provider Demographics
NPI:1457137994
Name:GRINBLAT, ALEXANDRA ERICA (MS)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:ERICA
Last Name:GRINBLAT
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6278 BOOTH ST
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-1562
Mailing Address - Country:US
Mailing Address - Phone:917-443-3474
Mailing Address - Fax:
Practice Address - Street 1:6278 BOOTH ST
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-1562
Practice Address - Country:US
Practice Address - Phone:917-443-3474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-31
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other