Provider Demographics
NPI:1144419292
Name:GALIBOV, IOSIF (RPA-C)
Entity Type:Individual
Prefix:
First Name:IOSIF
Middle Name:
Last Name:GALIBOV
Suffix:
Gender:M
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6435 YELLOWSTONE BLVD APT 2M
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-1727
Mailing Address - Country:US
Mailing Address - Phone:646-335-7453
Mailing Address - Fax:
Practice Address - Street 1:222 STATION PLZ N STE 428
Practice Address - Street 2:
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-3819
Practice Address - Country:US
Practice Address - Phone:516-663-3852
Practice Address - Fax:516-663-4617
Is Sole Proprietor?:No
Enumeration Date:2007-10-15
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012087363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant