Provider Demographics
NPI:1558349373
Name:RIBEIRO, ANIBAL EDGAR (MD)
Entity Type:Individual
Prefix:DR
First Name:ANIBAL
Middle Name:EDGAR
Last Name:RIBEIRO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ANIBAL
Other - Middle Name:EDGAR
Other - Last Name:RIBEIRO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1114 FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10310-2407
Mailing Address - Country:US
Mailing Address - Phone:718-720-1700
Mailing Address - Fax:718-876-8813
Practice Address - Street 1:1114 FOREST AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10310-2407
Practice Address - Country:US
Practice Address - Phone:718-720-1700
Practice Address - Fax:718-876-8813
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-03
Last Update Date:2010-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY140112207RH0003X
FLME89681207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00541382Medicaid
NY00541382Medicaid
NY38A351Medicare PIN