Healthcare Provider Details

I. General information

NPI: 1881008290
Provider Name (Legal Business Name): JOYCE TIBBETT DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2014
Last Update Date: 07/09/2020
Certification Date: 07/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

153 W GENESEE ST
CHITTENANGO NY
13037-1528
US

IV. Provider business mailing address

153 W GENESEE ST
CHITTENANGO NY
13037-1528
US

V. Phone/Fax

Practice location:
  • Phone: 315-687-5100
  • Fax: 315-687-0252
Mailing address:
  • Phone: 315-687-5100
  • Fax: 315-687-0252

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number274457
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: