MEDICARE: JENNIFER TIBBENS-SCALZO 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	267688	NY

General Provider Information

NPI Number	:	1982925491
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER TIBBENS-SCALZO MD

Provider Business Mailing Address
First Line	:	1150 CROSSPOINTE LN STE 1B
Second Line	:
City	:	WEBSTER
State	:	NY
Zip	:	14580-2995
Country	:	US
Telephone Number	:	585-667-5750
Fax Number	:	585-378-3490

Provider Business Practice Location Address
First Line	:	1150 CROSSPOINTE LN STE 1B
Second Line	:
City	:	WEBSTER
State	:	NY
Zip	:	14580-2995
Country	:	US
Telephone Number	:	585-667-5750
Fax Number	:	585-378-3490

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

Provider Enumeration Date	:	06/18/2010
Last Update Date	:	02/20/2026

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