MEDICARE: GREG RIBAKOVE M.D.

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	208600000X	Surgery Physician	152786	NY
2	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	152786	NY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	A400025191	OTHER	NY	MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1750377388
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GREG RIBAKOVE M.D.

Provider Business Mailing Address
First Line	:	PO BOX 30060
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10087-0060
Country	:	US
Telephone Number	:	718-283-7686
Fax Number	:	718-283-7392

Provider Business Practice Location Address
First Line	:	4802 10TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11219-2916
Country	:	US
Telephone Number	:	718-283-7686
Fax Number	:	718-283-7392

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

Provider Enumeration Date	:	09/20/2005
Last Update Date	:	02/24/2014

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