Healthcare Provider Details

I. General information

NPI: 1013120674
Provider Name (Legal Business Name): THERESA S CILIBERTI NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CRMI 1305 YORK AVENUE 6TH FLOOR
NEW YORK NY
10021-4866
US

IV. Provider business mailing address

1320 YORK AVE APT 23Q
NEW YORK NY
10021-4866
US

V. Phone/Fax

Practice location:
  • Phone: 917-952-5233
  • Fax:
Mailing address:
  • Phone: 917-952-5233
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberF420799-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: