Provider Demographics
NPI:1467608133
Name:KUNATH-TIBURZI, GAIL A (PA-C)
Entity Type:Individual
Prefix:MS
First Name:GAIL
Middle Name:A
Last Name:KUNATH-TIBURZI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:6 JEANETTE AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312-3609
Mailing Address - Country:US
Mailing Address - Phone:718-984-2291
Mailing Address - Fax:718-984-9221
Practice Address - Street 1:6 JEANETTE AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312-3609
Practice Address - Country:US
Practice Address - Phone:718-984-2291
Practice Address - Fax:718-984-9221
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-13
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY002669-1363A00000X
NJ25MP00141600363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant