Healthcare Provider Details

I. General information

NPI: 1326506981
Provider Name (Legal Business Name): JOSEPH A GRISPIN ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2019
Last Update Date: 04/13/2021
Certification Date: 04/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2051 BALDWIN RD STE 101
YORKTOWN HEIGHTS NY
10598-4047
US

IV. Provider business mailing address

50 OVERHILL RD
MAHOPAC NY
10541-2336
US

V. Phone/Fax

Practice location:
  • Phone: 914-302-2190
  • Fax:
Mailing address:
  • Phone: 845-591-7410
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number004154
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number1547
License Number StateCT
# 4
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: