Provider Demographics
NPI:1952874786
Name:GRUSKIN, MATTHEW ETAN (MBA, CO)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:ETAN
Last Name:GRUSKIN
Suffix:
Gender:M
Credentials:MBA, CO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1071 NE 83RD ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33138-4137
Mailing Address - Country:US
Mailing Address - Phone:561-702-3094
Mailing Address - Fax:
Practice Address - Street 1:1071 NE 83RD ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33138-4137
Practice Address - Country:US
Practice Address - Phone:561-702-3094
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-03
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLORT249222Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist