Provider Demographics
NPI:1285906552
Name:RAFFAELE GIBILISCO,MD,PA
Entity type:Organization
Organization Name:RAFFAELE GIBILISCO,MD,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAFFAELE
Authorized Official - Middle Name:
Authorized Official - Last Name:GIBILISCO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-295-1456
Mailing Address - Street 1:435 59TH ST
Mailing Address - Street 2:1ST FL
Mailing Address - City:WEST NEW YORK
Mailing Address - State:NJ
Mailing Address - Zip Code:07093-2107
Mailing Address - Country:US
Mailing Address - Phone:201-295-1456
Mailing Address - Fax:201-295-0266
Practice Address - Street 1:435 59TH ST
Practice Address - Street 2:1ST FL
Practice Address - City:WEST NEW YORK
Practice Address - State:NJ
Practice Address - Zip Code:07093-2107
Practice Address - Country:US
Practice Address - Phone:201-295-1456
Practice Address - Fax:201-295-0266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-02
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty