Provider Demographics
NPI:1477880771
Name:GRIBBIN, ROBERT E
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:E
Last Name:GRIBBIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 W MAIN ST
Mailing Address - Street 2:SUITE 340
Mailing Address - City:BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11702-3012
Mailing Address - Country:US
Mailing Address - Phone:631-661-3180
Mailing Address - Fax:631-661-3183
Practice Address - Street 1:400 W MAIN STREET
Practice Address - Street 2:SUITE 340
Practice Address - City:BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11702
Practice Address - Country:US
Practice Address - Phone:631-661-3180
Practice Address - Fax:631-661-3183
Is Sole Proprietor?:No
Enumeration Date:2009-11-06
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027317225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist