Provider Demographics
NPI:1255403705
Name:RICHARD D. GREBOSKY D.P.M., P.C.
Entity type:Organization
Organization Name:RICHARD D. GREBOSKY D.P.M., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:GREBOSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:814-443-2245
Mailing Address - Street 1:PO BOX 168
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:PA
Mailing Address - Zip Code:15501-0168
Mailing Address - Country:US
Mailing Address - Phone:814-443-2245
Mailing Address - Fax:814-443-0901
Practice Address - Street 1:451 STOYSTOWN RD
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:PA
Practice Address - Zip Code:15501-6927
Practice Address - Country:US
Practice Address - Phone:814-443-2245
Practice Address - Fax:814-443-0901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC003694R213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU33459Medicare UPIN
PA057658Medicare ID - Type Unspecified