Healthcare Provider Details

I. General information

NPI: 1164912432
Provider Name (Legal Business Name): HIBA BILAL DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2018
Last Update Date: 09/13/2023
Certification Date: 09/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 E ADAMS ST
SYRACUSE NY
13210-2306
US

IV. Provider business mailing address

4603 PROVIDENCE RD
JAMESVILLE NY
13078-6503
US

V. Phone/Fax

Practice location:
  • Phone: 315-464-5240
  • Fax:
Mailing address:
  • Phone: 207-299-3429
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberH97645
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberH97645
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: