Provider Demographics
NPI:1851979447
Name:GRINBERG, KIRILL (DPM)
Entity type:Individual
Prefix:
First Name:KIRILL
Middle Name:
Last Name:GRINBERG
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 S MAIN RD
Mailing Address - Street 2:
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08360-7828
Mailing Address - Country:US
Mailing Address - Phone:856-691-2152
Mailing Address - Fax:856-696-3474
Practice Address - Street 1:150 S MAIN RD
Practice Address - Street 2:
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-7828
Practice Address - Country:US
Practice Address - Phone:856-691-2152
Practice Address - Fax:856-696-3474
Is Sole Proprietor?:No
Enumeration Date:2021-04-01
Last Update Date:2025-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00389400213E00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program