Healthcare Provider Details

I. General information

NPI: 1669676110
Provider Name (Legal Business Name): DR. JOSE FRANK TIBURCIO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1276 FULTON AVE # 3F
BRONX NY
10456-3402
US

IV. Provider business mailing address

10205 187TH ST
HOLLIS NY
11423-3109
US

V. Phone/Fax

Practice location:
  • Phone: 718-901-8294
  • Fax:
Mailing address:
  • Phone: 646-267-8356
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number244497
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: