Provider Demographics
NPI:1750377388
Name:RIBAKOVE, GREG (MD)
Entity type:Individual
Prefix:
First Name:GREG
Middle Name:
Last Name:RIBAKOVE
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:PO BOX 30060
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10087-0060
Mailing Address - Country:US
Mailing Address - Phone:718-283-7686
Mailing Address - Fax:718-283-7392
Practice Address - Street 1:4802 10TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-2916
Practice Address - Country:US
Practice Address - Phone:718-283-7686
Practice Address - Fax:718-283-7392
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2014-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY152786208600000X, 208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01080244Medicaid
NYA400025191OtherMEDICARE PTAN
NYA400025191OtherMEDICARE PTAN
NY01080244Medicaid