Active NPI
Johanna Pino Grisales, M.S. CCC-SLP, TSSLD
- Speech-Language Pathologist
- New York, NY
National Provider Identifier
1235730565
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 030217
- Practice address
- 575 8TH Ave FL 6
New York, NY 10018-3158 - Phone
- (212) 221-1544
- NPI assigned
- Nov 3, 2020
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 030217 | NY | Primary |
Addresses
Primary practice location
575 8TH Ave FL 6
New York, NY 10018-3158
Mailing address
6704 Myrtle Ave # 1533
Glendale, NY 11385-7058
Phone (929) 241-7175
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 030217 | Other | NY | THE UNIVERSITY OF THE STATE OF NEW YORK EDUCATION DEPARTMENT |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 030217 | NY | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1604361600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1604361600000",
"number": "1235730565",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6704 MYRTLE AVE # 1533",
"city": "GLENDALE",
"state": "NY",
"postal_code": "113857058",
"telephone_number": "929-241-7175"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "575 8TH AVE FL 6",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100183158",
"telephone_number": "212-221-1544"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PINO GRISALES",
"first_name": "JOHANNA",
"credential": "M.S. CCC-SLP, TSSLD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-11-03",
"last_updated": "2020-11-03",
"certification_date": "2020-11-03",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Speech-Language Pathologist",
"state": "NY",
"license": "030217",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "THE UNIVERSITY OF THE STATE OF NEW YORK EDUCATION DEPARTMENT",
"identifier": "030217",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in New York, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.