Provider Demographics
NPI:1003951112
Name:GRIBBIN, DOROTA MALYSZEK
Entity Type:Individual
Prefix:
First Name:DOROTA
Middle Name:MALYSZEK
Last Name:GRIBBIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2333 WHITEHORSE MERCERVILLE RD
Mailing Address - Street 2:STE 8
Mailing Address - City:MERCERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08619-1946
Mailing Address - Country:US
Mailing Address - Phone:609-588-0540
Mailing Address - Fax:
Practice Address - Street 1:2333 WHITEHORSE MERCERVILLE RD
Practice Address - Street 2:SUITE 8
Practice Address - City:MERCERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08619-1946
Practice Address - Country:US
Practice Address - Phone:609-588-0540
Practice Address - Fax:609-588-0197
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MAO5867000208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJF39980Medicare UPIN
733754Medicare ID - Type Unspecified