Healthcare Provider Details

I. General information

NPI: 1366379760
Provider Name (Legal Business Name): SORIAH GIBSON LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 LONGWOOD RD
MIDDLE ISLAND NY
11953-2045
US

IV. Provider business mailing address

29 ROBINWOOD AVE
HEMPSTEAD NY
11550-6518
US

V. Phone/Fax

Practice location:
  • Phone: 631-924-0008
  • Fax:
Mailing address:
  • Phone: 631-924-0008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number334975
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: