Healthcare Provider Details

I. General information

NPI: 1053243907
Provider Name (Legal Business Name): RICHARD GIBBS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 MOUNT CARMEL AVE
HAMDEN CT
06518-1908
US

IV. Provider business mailing address

92 NEWTOWN AVE
NORWALK CT
06851-3027
US

V. Phone/Fax

Practice location:
  • Phone: 800-462-1944
  • Fax:
Mailing address:
  • Phone: 860-462-1944
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: