Organization Active NPI

Viktor Gribenko MD PC

  • Physical Medicine & Rehabilitation Physician
  • Brooklyn, NY
National Provider Identifier
1356424378
Registry record updated Jan 18, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
Legal business name
VIKTOR GRIBENKO MD PC
Practice address
170 Avenue S
Brooklyn, NY 11223-2633
Phone
(718) 946-7967
Fax
(718) 946-7964
NPI assigned
Oct 23, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 18, 2008

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

Authorized official

Name
Dr. Viktor Gribenko, MD
Title
President
Phone
(718) 946-7967

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Medicine & Rehabilitation PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208100000X Primary

Addresses

Primary practice location

170 Avenue S
Brooklyn, NY 11223-2633

Mailing address

9964 3Rd Ave
Brooklyn, NY 11209-7936
Phone (718) 946-7967

Other identifiers 2

IdentifierTypeStateIssuer
W81711OtherNYMEDICARE PROVIDER NUMBER
01933513MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20071115000584 NY Part B Supplier - Clinic/Group Practice 1951499599 Practice locations: Brooklyn, NY

National Provider Directory

National Provider Directory

Locations

242 E 19th St
#3
New York, NY 10003
Phone (212) 475-6249

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1161561600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1200614400000",
    "number": "1356424378",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9964 3RD AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112097936",
            "telephone_number": "718-946-7967",
            "fax_number": "718-946-7964"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "170 AVENUE S",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112232633",
            "telephone_number": "718-946-7967",
            "fax_number": "718-946-7964"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VIKTOR GRIBENKO MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-23",
        "last_updated": "2008-01-18",
        "status": "A",
        "authorized_official_last_name": "GRIBENKO",
        "authorized_official_first_name": "VIKTOR",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "718-946-7967",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PROVIDER NUMBER",
            "identifier": "W81711",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01933513",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.