Provider Demographics
NPI:1811644321
Name:PING, GRAINNE
Entity type:Individual
Prefix:
First Name:GRAINNE
Middle Name:
Last Name:PING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 BAYBERRY AVE
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08723-5568
Mailing Address - Country:US
Mailing Address - Phone:732-567-0542
Mailing Address - Fax:
Practice Address - Street 1:LIONS HEAD OFFICE PARK
Practice Address - Street 2:35 BEAVERSON BLVD
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08723
Practice Address - Country:US
Practice Address - Phone:888-557-8669
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-04
Last Update Date:2022-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center