Provider Demographics
NPI:1447348990
Name:GRINKOVITCH, JEFF (MPT)
Entity type:Individual
Prefix:MR
First Name:JEFF
Middle Name:
Last Name:GRINKOVITCH
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 RUCKNER RD
Mailing Address - Street 2:
Mailing Address - City:WESTWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07675-3308
Mailing Address - Country:US
Mailing Address - Phone:201-594-1118
Mailing Address - Fax:
Practice Address - Street 1:125 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:DUMONT
Practice Address - State:NJ
Practice Address - Zip Code:07628-3066
Practice Address - Country:US
Practice Address - Phone:201-385-6272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA011343002251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic