Provider Demographics
NPI:1124337902
Name:PHILIBERT, AISHA (RN)
Entity type:Individual
Prefix:
First Name:AISHA
Middle Name:
Last Name:PHILIBERT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 ELM AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10550-2356
Mailing Address - Country:US
Mailing Address - Phone:718-216-9848
Mailing Address - Fax:
Practice Address - Street 1:99 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:SUFFERN
Practice Address - State:NY
Practice Address - Zip Code:10901-6026
Practice Address - Country:US
Practice Address - Phone:845-357-4500
Practice Address - Fax:845-357-5039
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-28
Last Update Date:2010-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY574483163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse