Provider Demographics
NPI:1003096538
Name:VINCENT B CIBELLA
Entity Type:Organization
Organization Name:VINCENT B CIBELLA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:
Authorized Official - Last Name:CIBELLA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:440-460-6353
Mailing Address - Street 1:2751 TIMBERLINE DR
Mailing Address - Street 2:
Mailing Address - City:CORTLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44410-9275
Mailing Address - Country:US
Mailing Address - Phone:440-466-6353
Mailing Address - Fax:440-466-6269
Practice Address - Street 1:810 W MAIN ST
Practice Address - Street 2:SUITE A
Practice Address - City:GENEVA
Practice Address - State:OH
Practice Address - Zip Code:44041-1219
Practice Address - Country:US
Practice Address - Phone:440-466-6353
Practice Address - Fax:440-466-6269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-13
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36002567213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0194010001Medicare NSC