MEDICARE: JOSEPH A GRISPIN ATC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2255A2300X	Athletic Trainer	004154	NY
2	2255A2300X	Athletic Trainer	1547	CT
3	390200000X	Student in an Organized Health Care Education/Training Program
4	2255A2300X	Athletic Trainer

General Provider Information

NPI Number	:	1326506981
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPH A GRISPIN ATC

Provider Business Mailing Address
First Line	:	50 OVERHILL RD
Second Line	:
City	:	MAHOPAC
State	:	NY
Zip	:	10541-2336
Country	:	US
Telephone Number	:	845-591-7410
Fax Number	:

Provider Business Practice Location Address
First Line	:	2051 BALDWIN RD STE 101
Second Line	:
City	:	YORKTOWN HEIGHTS
State	:	NY
Zip	:	10598-4047
Country	:	US
Telephone Number	:	914-302-2190
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/03/2019
Last Update Date	:	04/13/2021

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