Healthcare Provider Details

I. General information

NPI: 1770287120
Provider Name (Legal Business Name): SUBIN SIBY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2023
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 MENDON RD
WOONSOCKET RI
02895-2411
US

IV. Provider business mailing address

202 PAINE ST APT A
BELLINGHAM MA
02019-2539
US

V. Phone/Fax

Practice location:
  • Phone: 401-769-5011
  • Fax:
Mailing address:
  • Phone: 267-261-1326
  • Fax: 508-473-2275

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0000X
TaxonomySports Medicine Podiatrist
License NumberDPM00386
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberDPM00386
License Number StateRI
# 3
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberDPM00386
License Number StateRI
# 4
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberDPM00386
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: