Individual provider Active NPI

Bruce Gribetz, M.D.

  • Pediatrics Physician
  • Spring Valley, NY
National Provider Identifier
1225143050
Registry record updated Dec 11, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
165273 Issued in NY
Practice address
728 N Main St
Spring Valley, NY 10977-1960
Phone
(845) 354-9300
Fax
(845) 354-4298
NPI assigned
Aug 20, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 11, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 165273 NY Primary

Addresses

Primary practice location

728 N Main St
Spring Valley, NY 10977-1960

Mailing address

728 N Main St
Spring Valley, NY 10977-8916
Phone (845) 354-9300

Other identifiers 1

IdentifierTypeStateIssuer
01421705MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
165273NYMDPediatrics Physician

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156032000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1197331200000",
    "number": "1225143050",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "728 N MAIN ST",
            "city": "SPRING VALLEY",
            "state": "NY",
            "postal_code": "109778916",
            "telephone_number": "845-354-9300",
            "fax_number": "845-354-4298"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "728 N MAIN ST",
            "city": "SPRING VALLEY",
            "state": "NY",
            "postal_code": "109771960",
            "telephone_number": "845-354-9300",
            "fax_number": "845-354-4298"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRIBETZ",
        "first_name": "BRUCE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-20",
        "last_updated": "2007-12-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NY",
            "license": "165273",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01421705",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Spring Valley, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.