Healthcare Provider Details

I. General information

NPI: 1326556309
Provider Name (Legal Business Name): DUNIA THELMA GIBSON FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2018
Last Update Date: 10/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 PROSPECT ST
HACKENSACK NJ
07601-6081
US

IV. Provider business mailing address

6010 BAY PKWY STE 901
BROOKLYN NY
11204-6081
US

V. Phone/Fax

Practice location:
  • Phone: 551-996-5430
  • Fax: 551-996-5729
Mailing address:
  • Phone: 718-238-2100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ00903200
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number342462
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier342462
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerFAMILY NURSE PRACTITIONER
# 2
Identifier342462
Identifier TypeMEDICAID
Identifier StateNY
Identifier Issuer
# 3
Identifier342462
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerFNP

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: