Healthcare Provider Details

I. General information

NPI: 1003096538
Provider Name (Legal Business Name): VINCENT B CIBELLA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2007
Last Update Date: 09/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 W MAIN ST SUITE A
GENEVA OH
44041-1219
US

IV. Provider business mailing address

2751 TIMBERLINE DR
CORTLAND OH
44410-9275
US

V. Phone/Fax

Practice location:
  • Phone: 440-466-6353
  • Fax: 440-466-6269
Mailing address:
  • Phone: 440-466-6353
  • Fax: 440-466-6269

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number36002567
License Number StateOH

VIII. Authorized Official

Name: VINCENT CIBELLA
Title or Position: PODIATRIST OWNER
Credential: DPM
Phone: 440-460-6353