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General NPI Number Information
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NPI Number | 1053502724
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Entity Type | Organization
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Legal Business Name | VIKTOR GRIBENKO MD PC
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Dates
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Enumeration Date | 08/07/2007
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Last Update Date | 08/07/2007
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Provider Practice Location Address
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Address Line | 170 AVENUE S
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City | BROOKLYN
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State | NY
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Zip | 11223-2633
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Country | US
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Telephone | 718-946-7967
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Fax | 718-946-7964
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Provider Business Mailing Address
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Address Line | 170 AVENUE S
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City | BROOKLYN
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State | NY
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Zip | 11223-2633
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Country | US
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Telephone | 718-946-7967
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Fax | 718-946-7964
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. VIKTOR GRIBENKO
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Credential | MD
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Telephone | 718-946-7967
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number | 211122
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License Number State | NY
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