Healthcare Provider Details

I. General information

NPI: 1245385335
Provider Name (Legal Business Name): IBY DE GEORGE-GEAREY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 02/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

98-120 QUEENS BOULVARD
REGO PARK NY
11374
US

IV. Provider business mailing address

2600 NETHERLAND AVE APT 3105
BRONX NY
10463-4801
US

V. Phone/Fax

Practice location:
  • Phone: 718-830-0246
  • Fax:
Mailing address:
  • Phone: 718-884-4688
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: