MEDICARE: ROBERT GIBBON JR. 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	2084P0800X	Psychiatry Physician	197419	NY

General Provider Information

NPI Number	:	1992771190
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT GIBBON JR. MD

Provider Business Mailing Address
First Line	:	92 W. SUMMIT ST.
Second Line	:
City	:	LAKEWOOD
State	:	NY
Zip	:	14750
Country	:	US
Telephone Number	:	716-485-3690
Fax Number	:

Provider Business Practice Location Address
First Line	:	92 W. SUMMIT ST.
Second Line	:
City	:	LAKEWOOD
State	:	NY
Zip	:	14750
Country	:	US
Telephone Number	:	716-485-3690
Fax Number	:

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

Provider Enumeration Date	:	02/27/2006
Last Update Date	:	08/28/2018

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