Provider Demographics
NPI:1659574507
Name:JANE PRATT-GRIPPI D.P.M.,P.C.
Entity Type:Organization
Organization Name:JANE PRATT-GRIPPI D.P.M.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JANE
Authorized Official - Middle Name:IRENE
Authorized Official - Last Name:PRATT-GRIPPI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:718-225-7344
Mailing Address - Street 1:4729 193RD ST
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11358-3928
Mailing Address - Country:US
Mailing Address - Phone:718-225-7344
Mailing Address - Fax:718-225-7346
Practice Address - Street 1:4729 193RD ST
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11358-3928
Practice Address - Country:US
Practice Address - Phone:718-225-7344
Practice Address - Fax:718-225-7346
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-07
Last Update Date:2008-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN004315213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1134276520OtherNPI
NY01053910Medicaid
NYT92473Medicare UPIN
NY1134276520OtherNPI
5367710001Medicare NSC