Healthcare Provider Details

I. General information

NPI: 1174438204
Provider Name (Legal Business Name): GREGORY S. DIBELIUS, MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 E 60TH ST APT 4D
NEW YORK NY
10022-1164
US

IV. Provider business mailing address

121 E 60TH ST APT 4D
NEW YORK NY
10022-1164
US

V. Phone/Fax

Practice location:
  • Phone: 212-518-1036
  • Fax:
Mailing address:
  • Phone: 212-518-1036
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. GREGORY DIBELIUS
Title or Position: OWNER
Credential: MD
Phone: 212-518-1036