Provider Demographics
NPI:1154991412
Name:GRIN, ZACHARY (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:ZACHARY
Middle Name:
Last Name:GRIN
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 E 96TH ST APT 23Q
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-6212
Mailing Address - Country:US
Mailing Address - Phone:219-381-9518
Mailing Address - Fax:
Practice Address - Street 1:16 MADISON SQ W FL 11
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-0061
Practice Address - Country:US
Practice Address - Phone:646-397-2416
Practice Address - Fax:332-334-2990
Is Sole Proprietor?:No
Enumeration Date:2021-06-29
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA02007200225100000X
NY047350225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist