Provider Demographics
NPI:1205520798
Name:GRIDLEY, TOBY S (RN)
Entity type:Individual
Prefix:MR
First Name:TOBY
Middle Name:S
Last Name:GRIDLEY
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:319 W WATER ST
Mailing Address - Street 2:
Mailing Address - City:ELMIRA
Mailing Address - State:NY
Mailing Address - Zip Code:14901-2914
Mailing Address - Country:US
Mailing Address - Phone:607-734-3646
Mailing Address - Fax:607-734-3777
Practice Address - Street 1:319 W WATER ST
Practice Address - Street 2:
Practice Address - City:ELMIRA
Practice Address - State:NY
Practice Address - Zip Code:14901-2914
Practice Address - Country:US
Practice Address - Phone:607-734-3646
Practice Address - Fax:607-734-3777
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-07
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY567210163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health