Healthcare Provider Details

I. General information

NPI: 1275673154
Provider Name (Legal Business Name): NICHOLAS SIBINGA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

WEILER - DEPT. OF CARDIOLOGY 1825 EASTCHESTER ROAD
BRONX NY
10461
US

IV. Provider business mailing address

310 BEDFORD RD
CHAPPAQUA NY
10514-2714
US

V. Phone/Fax

Practice location:
  • Phone: 718-904-2927
  • Fax:
Mailing address:
  • Phone: 718-904-2927
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number218509
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: