Provider Demographics
NPI:1710912431
Name:GRUBER, BARRY L (MD)
Entity Type:Individual
Prefix:DR
First Name:BARRY
Middle Name:L
Last Name:GRUBER
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 1:500 W MAIN ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11702-3027
Mailing Address - Country:US
Mailing Address - Phone:631-376-2663
Mailing Address - Fax:631-376-4800
Practice Address - Street 1:500 W MAIN ST
Practice Address - Street 2:SUITE 110
Practice Address - City:BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11702-3027
Practice Address - Country:US
Practice Address - Phone:631-376-2663
Practice Address - Fax:631-376-4800
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2010-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY145236207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY4739F1OtherBC/BS
NY00825452Medicaid
NYCS396OtherOXFORD
NY1666152OtherAETNA
NY00825452Medicaid