Provider Demographics
NPI:1982925491
Name:TIBBENS-SCALZO, JENNIFER (MD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:TIBBENS-SCALZO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:TIBBENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:480 SANDYSTONE CIR
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:NY
Mailing Address - Zip Code:14580-1790
Mailing Address - Country:US
Mailing Address - Phone:607-316-0924
Mailing Address - Fax:
Practice Address - Street 1:1200 FAIRWAY 7
Practice Address - Street 2:
Practice Address - City:MACEDON
Practice Address - State:NY
Practice Address - Zip Code:14502-9392
Practice Address - Country:US
Practice Address - Phone:315-359-2830
Practice Address - Fax:315-986-4888
Is Sole Proprietor?:No
Enumeration Date:2010-06-18
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY267688207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine