MEDICARE: ANGELA GIBBS CPCP

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	174400000X	Specialist

General Provider Information

NPI Number	:	1871018549
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA GIBBS CPCP

Provider Business Mailing Address
First Line	:	250 PRINCE AVE
Second Line	:
City	:	FREEPORT
State	:	NY
Zip	:	11520-1022
Country	:	US
Telephone Number	:	347-881-6767
Fax Number	:

Provider Business Practice Location Address
First Line	:	206 LIVINGSTON ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11201-5811
Country	:	US
Telephone Number	:	516-939-4752
Fax Number	:

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

Provider Enumeration Date	:	08/03/2017
Last Update Date	:	03/17/2018

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