Healthcare Provider Details

I. General information

NPI: 1972571065
Provider Name (Legal Business Name): MARY HIBBARD PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 10/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 E 98TH ST BOX 1240B
NEW YORK NY
10029-6501
US

IV. Provider business mailing address

5 E. 98TH STREET 6TH FLOOR BOX 1240B
NEW YORK NY
10029
US

V. Phone/Fax

Practice location:
  • Phone: 212-659-9363
  • Fax: 212-348-5901
Mailing address:
  • Phone: 212-659-9363
  • Fax: 212-348-5901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number008280-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: