Organization
VIKTOR GRIBENKO MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. VIKTOR GRIBENKO MD (PRESIDENT)
(718) 946-7967
Entity
Organization
Contact information
Practice address
170 AVENUE S, BROOKLYN, NY 11223-2633
(718) 946-7967
(718) 946-7964
Mailing address
9964 3RD AVE, BROOKLYN, NY 11209-7936
(718) 946-7967
(718) 946-7964
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01933513
—
NY
01
—
W81711
MEDICARE PROVIDER NUMBER
NY
Enumeration date
10/23/2006
Last updated
01/18/2008
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