Provider Demographics
NPI:1396847877
Name:GRIBIK, JOSEPH J (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:J
Last Name:GRIBIK
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 1:124 EVANS RD
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:PA
Mailing Address - Zip Code:16001-1970
Mailing Address - Country:US
Mailing Address - Phone:724-287-6259
Mailing Address - Fax:
Practice Address - Street 1:124 EVANS RD
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:PA
Practice Address - Zip Code:16001-1970
Practice Address - Country:US
Practice Address - Phone:724-287-6259
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD022335E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
C28552Medicare UPIN
GR057649Medicare ID - Type Unspecified