Provider Demographics
NPI:1255449518
Name:GRIPPO, PATRICK J (DPM)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:J
Last Name:GRIPPO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 CLOCK TOWER CMNS
Mailing Address - Street 2:
Mailing Address - City:BREWSTER
Mailing Address - State:NY
Mailing Address - Zip Code:10509-4055
Mailing Address - Country:US
Mailing Address - Phone:845-592-4915
Mailing Address - Fax:
Practice Address - Street 1:111 CLOCK TOWER CMNS
Practice Address - Street 2:
Practice Address - City:BREWSTER
Practice Address - State:NY
Practice Address - Zip Code:10509-4055
Practice Address - Country:US
Practice Address - Phone:845-279-5187
Practice Address - Fax:845-279-5168
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-28
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005738-1213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02182176Medicaid
P00321765OtherMEDICARE RAILROAD PTAN
NYPG4122Medicare PIN
NYPG0PG41210Medicare PIN
NY4686740001Medicare NSC
NYPG4121Medicare PIN
P00321765OtherMEDICARE RAILROAD PTAN
NYPG0PG41220Medicare PIN