Provider Demographics
NPI:1073511622
Name:GULBRANSEN, GREG (DO)
Entity Type:Individual
Prefix:DR
First Name:GREG
Middle Name:
Last Name:GULBRANSEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:OYSTER BAY
Mailing Address - State:NY
Mailing Address - Zip Code:11771-2910
Mailing Address - Country:US
Mailing Address - Phone:516-922-3131
Mailing Address - Fax:516-922-5218
Practice Address - Street 1:229 SOUTH ST
Practice Address - Street 2:
Practice Address - City:OYSTER BAY
Practice Address - State:NY
Practice Address - Zip Code:11771-2910
Practice Address - Country:US
Practice Address - Phone:516-922-3131
Practice Address - Fax:516-922-5218
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY205715-1208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0099840-002OtherCIGNA
NY108783OtherVYTRA
NY1938888002OtherUNITED HEALTH
NYOB203OtherBLUE CROSS
NYNS0002187OtherSELECT PRO
NY2698521OtherGHI
NY2C7659OtherPHCS
NY7734061OtherAETNA
NY02232162Medicaid
NYP2160711OtherOXFORD