Healthcare Provider Details

I. General information

NPI: 1013943448
Provider Name (Legal Business Name): GARY N GRIPPO D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2006
Last Update Date: 10/27/2021
Certification Date: 10/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

189 DURHAM ROAD
GUILFORD CT
06437
US

IV. Provider business mailing address

189 DURHAM ROAD
GUILFORD CT
06437
US

V. Phone/Fax

Practice location:
  • Phone: 203-799-3668
  • Fax: 203-891-0766
Mailing address:
  • Phone: 203-799-3668
  • Fax: 203-891-0766

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number000481
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number000481
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: