Healthcare Provider Details

I. General information

NPI: 1659554343
Provider Name (Legal Business Name): MARGARET CIBOTTI ALEX NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2007
Last Update Date: 02/11/2021
Certification Date: 02/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 NESCONSET HWY BLDG #3C
STONY BROOK NY
11790-2555
US

IV. Provider business mailing address

26 FAIRVIEW ST
HUNTINGTON NY
11743-3414
US

V. Phone/Fax

Practice location:
  • Phone: 631-751-2400
  • Fax: 631-751-8323
Mailing address:
  • Phone: 631-271-3329
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number304226
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: