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NPI Code Detail

MEDICARE: JOHN LIAM GIBBONS

MEDICARE: JOHN LIAM GIBBONS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1477351369
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHN LIAM GIBBONS
Provider Business Mailing Address
First Line : 445 LENOX RD
Second Line :
City : BROOKLYN
State : NY
Zip : 11203-2017
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 445 LENOX RD
Second Line :
City : BROOKLYN
State : NY
Zip : 11203-2017
Country : US
Telephone Number : 215-955-6983
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/05/2025
Last Update Date : 04/10/2026

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