Healthcare Provider Details

I. General information

NPI: 1679223747
Provider Name (Legal Business Name): GIBBS ORTHODONTIC ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2022
Last Update Date: 03/24/2022
Certification Date: 03/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 EAST 84TH STREET
NEW YORK NY
10028
US

IV. Provider business mailing address

40 EAST 84TH STREET
NEW YORK NY
10028
US

V. Phone/Fax

Practice location:
  • Phone: 212-535-4111
  • Fax: 212-535-7631
Mailing address:
  • Phone: 212-535-4111
  • Fax: 212-535-7631

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. ERIC P. GIBBS
Title or Position: OWNER/DENTIST
Credential: D.D.S.
Phone: 212-535-4111