Provider Demographics
NPI:1285936815
Name:GRIMSON, SUJAAN MARGARET (LAC)
Entity type:Individual
Prefix:MS
First Name:SUJAAN
Middle Name:MARGARET
Last Name:GRIMSON
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 W 34TH ST
Mailing Address - Street 2:6G
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-2303
Mailing Address - Country:US
Mailing Address - Phone:212-563-0069
Mailing Address - Fax:212-563-0069
Practice Address - Street 1:440 W 34TH ST
Practice Address - Street 2:6G
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-2303
Practice Address - Country:US
Practice Address - Phone:212-563-0069
Practice Address - Fax:212-563-0069
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-02
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000577-1171100000X
CA4263171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist