Provider Demographics
NPI:1255651873
Name:GIBIEZAITE, SANDRA (MD)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:GIBIEZAITE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:
Other - Last Name:MESLINIENE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:57 WILLOWBROOK BLVD
Mailing Address - Street 2:SUITE 303
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-7045
Mailing Address - Country:US
Mailing Address - Phone:973-754-4060
Mailing Address - Fax:973-754-4007
Practice Address - Street 1:703 MAIN ST
Practice Address - Street 2:ST JOSEPH REGIONAL HOSPITAL CENTER, DEPT OF MEDICINE
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07503-2621
Practice Address - Country:US
Practice Address - Phone:973-754-2476
Practice Address - Fax:973-754-3376
Is Sole Proprietor?:No
Enumeration Date:2010-06-05
Last Update Date:2017-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTRN15122207RE0101X
WI57502-20207RE0101X
NC2012-01560207RE0101X
SC37469207RE0101X
NJ25MA09634400207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism