1073511622 NPI number — DR. GREG GULBRANSEN DO

Table of content: DR. GREG GULBRANSEN DO (NPI 1073511622)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073511622 NPI number — DR. GREG GULBRANSEN DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GULBRANSEN
Provider First Name:
GREG
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073511622
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
229 SOUTH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OYSTER BAY
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11771-2910
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-922-3131
Provider Business Mailing Address Fax Number:
516-922-5218

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
229 SOUTH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OYSTER BAY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11771-2910
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-922-3131
Provider Business Practice Location Address Fax Number:
516-922-5218
Provider Enumeration Date:
07/08/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  205715-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0099840-002 . This is a "CIGNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 108783 . This is a "VYTRA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1938888002 . This is a "UNITED HEALTH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: OB203 . This is a "BLUE CROSS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: NS0002187 . This is a "SELECT PRO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 2698521 . This is a "GHI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 2C7659 . This is a "PHCS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 7734061 . This is a "AETNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 02232162 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: P2160711 . This is a "OXFORD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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