Healthcare Provider Details

I. General information

NPI: 1225248818
Provider Name (Legal Business Name): DAVID SCOTT TIBER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 DALE RD STE 201
AVON CT
06001-3692
US

IV. Provider business mailing address

111 E 57TH ST RM 202
NEW YORK NY
10022-2645
US

V. Phone/Fax

Practice location:
  • Phone: 646-921-6266
  • Fax:
Mailing address:
  • Phone: 516-726-0336
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number77285
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number249455
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: