Provider Demographics
NPI:1972559425
Name:GRISHIN, LYDIA V (MD)
Entity type:Individual
Prefix:DR
First Name:LYDIA
Middle Name:V
Last Name:GRISHIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1365 YORK AVE
Mailing Address - Street 2:SUITE 19F
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-4035
Mailing Address - Country:US
Mailing Address - Phone:917-415-8420
Mailing Address - Fax:704-296-2305
Practice Address - Street 1:1365 YORK AVE
Practice Address - Street 2:SUITE 19F
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-4035
Practice Address - Country:US
Practice Address - Phone:917-415-8420
Practice Address - Fax:704-296-2305
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY223066207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH91279Medicare UPIN
NY5033L1Medicare PIN