Provider Demographics
NPI:1124028832
Name:CIBISCHINO, MAURIZIO (MD)
Entity Type:Individual
Prefix:DR
First Name:MAURIZIO
Middle Name:
Last Name:CIBISCHINO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 PLAZA CT
Mailing Address - Street 2:
Mailing Address - City:E STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18301-8263
Mailing Address - Country:US
Mailing Address - Phone:570-421-7020
Mailing Address - Fax:570-421-7091
Practice Address - Street 1:600 PLAZA CT
Practice Address - Street 2:
Practice Address - City:E STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301-8263
Practice Address - Country:US
Practice Address - Phone:570-421-7020
Practice Address - Fax:570-421-7091
Is Sole Proprietor?:No
Enumeration Date:2005-07-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD059546L207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA868749KCAOtherBLUE SHIELD
PAG26863Medicare UPIN
PA668323Medicare ID - Type Unspecified