Provider Demographics
NPI:1306163829
Name:SYRKIN, GRIGORY (MD)
Entity type:Individual
Prefix:
First Name:GRIGORY
Middle Name:
Last Name:SYRKIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 E 210TH ST
Mailing Address - Street 2:DEPARTMENT OF REHABILITATION
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-2412
Mailing Address - Country:US
Mailing Address - Phone:718-920-2751
Mailing Address - Fax:
Practice Address - Street 1:150 E 210TH ST
Practice Address - Street 2:DEPARTMENT OF REHABILITATION
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-2412
Practice Address - Country:US
Practice Address - Phone:718-920-2751
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-23
Last Update Date:2015-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY271736208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation