Healthcare Provider Details

I. General information

NPI: 1982925491
Provider Name (Legal Business Name): JENNIFER TIBBENS-SCALZO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JENNIFER TIBBENS MD

II. Dates (important events)

Enumeration Date: 06/18/2010
Last Update Date: 02/20/2026
Certification Date: 02/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 CROSSPOINTE LN STE 1B
WEBSTER NY
14580-2995
US

IV. Provider business mailing address

1150 CROSSPOINTE LN STE 1B
WEBSTER NY
14580-2995
US

V. Phone/Fax

Practice location:
  • Phone: 585-667-5750
  • Fax: 585-378-3490
Mailing address:
  • Phone: 585-667-5750
  • Fax: 585-378-3490

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number267688
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: