MEDICARE: MS. CONSTANCE BELIN GIBB M.S.

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
1	170300000X	Genetic Counselor (M.S.)

General Provider Information

NPI Number	:	1609865492
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CONSTANCE BELIN GIBB M.S.

Provider Business Mailing Address
First Line	:	525 E 68TH ST
Second Line	:	ROOM P-695
City	:	NEW YORK
State	:	NY
Zip	:	10021-4870
Country	:	US
Telephone Number	:	212-746-3972
Fax Number	:	212-746-8986

Provider Business Practice Location Address
First Line	:	525 E 68TH ST
Second Line	:	ROOM P-695
City	:	NEW YORK
State	:	NY
Zip	:	10021-4870
Country	:	US
Telephone Number	:	212-746-3972
Fax Number	:	212-746-8986

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/14/2005
Last Update Date	:	07/08/2007

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