Basic Information
Provider Information | |||||||||
NPI: | 1316302037 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | GRINMAN | ||||||||
FirstName: | ALINA | ||||||||
MiddleName: |   | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | PSYD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | FEYDER | ||||||||
OtherFirstName: | ALINA | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: | DR. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | PSYD | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 2094 ALBANY POST RD | ||||||||
Address2: | BUILDING 12 | ||||||||
City: | MONTROSE | ||||||||
State: | NY | ||||||||
PostalCode: | 105481454 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9147374400 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 2094 ALBANY POST RD | ||||||||
Address2: | BUILDING 12 | ||||||||
City: | MONTROSE | ||||||||
State: | NY | ||||||||
PostalCode: | 105481454 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9147374400 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 12/22/2015 | ||||||||
LastUpdateDate: | 12/22/2015 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | 021487 | NY | Y |   | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.