Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 000481 | CT |
Y | 222Z00000X | Podiatrist | 000481 | CT |
N | 213ES0131X | Foot Surgery | 000481 | CT |
NPI | 1013943448 |
---|---|
Provider Name | Dr. Gary N Grippo |
First Address | Guilford, CT 06437 |
Second Address | Guilford, CT 06437 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2006 |
Last Update Date | 27/10/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
004213279 | (05) | CT |
T88960 | (02) | CT |