Provider Demographics
NPI:1487689899
Name:GRIBETZ, MICHAEL ELLIOT (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ELLIOT
Last Name:GRIBETZ
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 1:1155 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128
Mailing Address - Country:US
Mailing Address - Phone:212-831-1300
Mailing Address - Fax:212-860-7884
Practice Address - Street 1:1155 PARK AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128
Practice Address - Country:US
Practice Address - Phone:212-831-1300
Practice Address - Fax:212-860-7884
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY120663208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
339461Medicare ID - Type Unspecified
B13329Medicare UPIN