Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 040723 | NY |
NPI | 1124152582 |
---|---|
Provider Name | Dr. John Thomas Grbic |
First Address | Manhasset, NY 11030-2113 |
Second Address | New York, NY 10022-1002 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/03/2007 |
Last Update Date | 08/07/2007 |