Healthcare Provider Details

I. General information

NPI: 1144557752
Provider Name (Legal Business Name): WINSTON W GIBBONS R.N.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2009
Last Update Date: 11/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1709 E 174TH ST SUITE B
BRONX NY
10472-1753
US

IV. Provider business mailing address

1709 E 174TH ST SUITE B
BRONX NY
10472-1753
US

V. Phone/Fax

Practice location:
  • Phone: 914-346-6639
  • Fax: 718-502-9366
Mailing address:
  • Phone: 914-346-6639
  • Fax: 718-502-9366

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number450119
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: