Provider Demographics
NPI:1699084111
Name:GRIGOROFF, BETINA Y (RNC, BSN, CCE, IBCLC)
Entity type:Individual
Prefix:MS
First Name:BETINA
Middle Name:Y
Last Name:GRIGOROFF
Suffix:
Gender:F
Credentials:RNC, BSN, CCE, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 W 160TH ST
Mailing Address - Street 2:SUITE 6E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-5613
Mailing Address - Country:US
Mailing Address - Phone:212-928-3791
Mailing Address - Fax:
Practice Address - Street 1:601 W 160TH ST
Practice Address - Street 2:SUITE 6E
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-5613
Practice Address - Country:US
Practice Address - Phone:212-928-3791
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-30
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY197-13965163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA197-13965OtherINTERNATIONAL BOARD OF LACTATION CONSULTANT EXAMINER ( IBLCE )