Provider Demographics
NPI:1205868304
Name:GRIBIN, BRADLEY (MD)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:
Last Name:GRIBIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300B PRINCETON HIGHTSTOWN RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:EAST WINDSOR
Mailing Address - State:NJ
Mailing Address - Zip Code:08520-1400
Mailing Address - Country:US
Mailing Address - Phone:609-448-7300
Mailing Address - Fax:
Practice Address - Street 1:300B PRINCETON HIGHTSTOWN RD
Practice Address - Street 2:SUITE 203
Practice Address - City:EAST WINDSOR
Practice Address - State:NJ
Practice Address - Zip Code:08520-1400
Practice Address - Country:US
Practice Address - Phone:609-448-7300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2014-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06483100208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
2695913OtherGHI
360713OtherAMERIHEALTH PPO
0683394000OtherAMERIHEALTH HMO
10657716OtherCAQH
2K2596OtherHEALTHNET