Provider Demographics
NPI:1427082932
Name:MICHAEL E. GRIBETZ, MD PC
Entity type:Organization
Organization Name:MICHAEL E. GRIBETZ, MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:GRIBETZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-831-1300
Mailing Address - Street 1:1155 PARK AVENUE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128
Mailing Address - Country:US
Mailing Address - Phone:212-831-1300
Mailing Address - Fax:212-860-7884
Practice Address - Street 1:1155 PARK AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-1209
Practice Address - Country:US
Practice Address - Phone:212-831-1300
Practice Address - Fax:212-860-7884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY120663174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB13329Medicare UPIN