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General NPI Number Information
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NPI Number | 1306884440
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Entity Type | Organization
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Legal Business Name | ORANGETOWN FAMILY PRACTICE
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Dates
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Enumeration Date | 06/02/2006
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Last Update Date | 07/02/2009
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Provider Practice Location Address
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Address Line | 97 ROUTE 303
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City | TAPPAN
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State | NY
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Zip | 10983-2514
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Country | US
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Telephone | 845-359-5005
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Fax |
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Provider Business Mailing Address
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Address Line | 97 ROUTE 303
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City | TAPPAN
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State | NY
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Zip | 10983-2514
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Country | US
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Telephone | 845-359-5005
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Fax |
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Authorized Official
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Title or Position | PARTNER
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Name | VINCENT M IBELLI
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Credential | MD
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Telephone | 845-359-5005
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 167148-1
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License Number State | NY
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