MEDICARE: VINCENT M IBELLI MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	167148-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033119599
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VINCENT M IBELLI MD

Provider Business Mailing Address
First Line	:	155 CRYSTAL RUN RD
Second Line	:
City	:	MIDDLETOWN
State	:	NY
Zip	:	10941-4028
Country	:	US
Telephone Number	:	845-703-6999
Fax Number	:	845-703-6297

Provider Business Practice Location Address
First Line	:	97 ROUTE 303
Second Line	:
City	:	TAPPAN
State	:	NY
Zip	:	10983-2514
Country	:	US
Telephone Number	:	845-359-5005
Fax Number	:	845-359-2281

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/27/2005
Last Update Date	:	02/10/2015

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