Provider Demographics
NPI:1407932577
Name:CIBOROWSKI, PAUL JOHN
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:JOHN
Last Name:CIBOROWSKI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 284
Mailing Address - Street 2:
Mailing Address - City:SHOREHAM
Mailing Address - State:NY
Mailing Address - Zip Code:11786-0284
Mailing Address - Country:US
Mailing Address - Phone:631-821-1343
Mailing Address - Fax:631-821-1343
Practice Address - Street 1:38 MARY PITKIN PATH
Practice Address - Street 2:
Practice Address - City:SHOREHAM
Practice Address - State:NY
Practice Address - Zip Code:11786-1137
Practice Address - Country:US
Practice Address - Phone:631-821-1343
Practice Address - Fax:631-821-1343
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001900101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health