Basic Information
| Provider Information | |||||||||
| NPI: | 1114213717 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GREVTSEVA | ||||||||
| FirstName: | LAYSA | ||||||||
| MiddleName: | |||||||||
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| Credential: | MS. EDUCATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7000 AUSTIN STREET | ||||||||
| Address2: | #200 | ||||||||
| City: | FOREST HILLS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11375 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7187627633 | ||||||||
| FaxNumber: | 7188868694 | ||||||||
| Practice Location | |||||||||
| Address1: | 7000 AUSTIN STREET | ||||||||
| Address2: | #200 | ||||||||
| City: | FOREST HILLS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11375 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7187627633 | ||||||||
| FaxNumber: | 7188868694 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2011 | ||||||||
| LastUpdateDate: | 01/05/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | Y | Other Service Providers | Specialist |
No ID Information.