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General NPI Number Information
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NPI Number | 1205067774
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Entity Type | Organization
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Legal Business Name | SANDRA GILBAN MD PC
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Dates
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Enumeration Date | 08/02/2009
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Last Update Date | 08/02/2009
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Provider Practice Location Address
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Address Line | 911 PARK AVE
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City | NEW YORK
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State | NY
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Zip | 10075-0385
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Country | US
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Telephone | 212-288-7388
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Fax | 212-288-7735
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Provider Business Mailing Address
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Address Line | 125 E 87TH ST APT 4D
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City | NEW YORK
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State | NY
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Zip | 10128-1125
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Country | US
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Telephone | 917-743-6838
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Fax | 212-288-7735
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Authorized Official
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Title or Position | PRESIDENT
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Name | SANDRA GILBAN
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Credential | MD
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Telephone | 917-743-6838
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 206109
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License Number State | NY
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