Provider Demographics
NPI:1174577795
Name:GREYMAN, MARINA (DPM)
Entity type:Individual
Prefix:DR
First Name:MARINA
Middle Name:
Last Name:GREYMAN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:266 SLOCUM WAY
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-5306
Mailing Address - Country:US
Mailing Address - Phone:917-753-6376
Mailing Address - Fax:
Practice Address - Street 1:6420 108TH ST
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-1604
Practice Address - Country:US
Practice Address - Phone:718-520-6500
Practice Address - Fax:718-520-6595
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN006157213E00000X
NJ25MD00287100213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist