Provider Demographics
NPI:1285397182
Name:CIBELLI, MICHAEL DOMINICK (PA-C)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:DOMINICK
Last Name:CIBELLI
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:60 PRICE CT
Mailing Address - Street 2:
Mailing Address - City:DENVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07834-2176
Mailing Address - Country:US
Mailing Address - Phone:610-295-4473
Mailing Address - Fax:
Practice Address - Street 1:174 EDISON RD
Practice Address - Street 2:
Practice Address - City:LAKE HOPATCONG
Practice Address - State:NJ
Practice Address - Zip Code:07849-2217
Practice Address - Country:US
Practice Address - Phone:973-663-2700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-18
Last Update Date:2021-10-18
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant