Provider Demographics
NPI:1134276520
Name:PRATT-GRIPPI, JANE (DPM)
Entity type:Individual
Prefix:DR
First Name:JANE
Middle Name:
Last Name:PRATT-GRIPPI
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2015-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN004315213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY5367710001OtherDMERC
NYP043159OtherWOEKER'S COMPENSATION
NY01053910Medicaid
NY5367710001OtherDMERC
NYP043159OtherWOEKER'S COMPENSATION