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General NPI Number Information
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NPI Number | 1407478464
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Entity Type | Individual
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Provider Name | JESSICA GIBSON BC HAD
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Gender | Female
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Dates
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Enumeration Date | 05/13/2020
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Last Update Date | 08/04/2021
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Provider Practice Location Address
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Address Line | 1300 UNION TPKE STE 103A
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City | NEW HYDE PARK
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State | NY
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Zip | 11040-1759
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Country | US
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Telephone | 516-588-6742
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Fax |
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Provider Business Mailing Address
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Address Line | 11818 199TH ST
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City | SAINT ALBANS
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State | NY
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Zip | 11412-3430
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Country | US
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Telephone | 337-274-3670
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 237700000X
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Taxonomy Name | Hearing Instrument Specialist
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License Number | 14000061292
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License Number State | NY
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