Basic Information
| Provider Information | |||||||||
| NPI: | 1447348990 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GRINKOVITCH | ||||||||
| FirstName: | JEFF | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | MPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14 RUCKNER RD | ||||||||
| Address2: | |||||||||
| City: | WESTWOOD | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 076753308 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2015941118 | ||||||||
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| Practice Location | |||||||||
| Address1: | 125 WASHINGTON AVE | ||||||||
| Address2: | |||||||||
| City: | DUMONT | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 076283066 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2013856272 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/10/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2251X0800X | 40QA01134300 | NJ | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Orthopedic |
No ID Information.