Provider Demographics
NPI:1841241114
Name:GIBILARO, SALLY ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:SALLY
Middle Name:ANN
Last Name:GIBILARO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:143 82ND ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-4342
Mailing Address - Country:US
Mailing Address - Phone:718-836-6600
Mailing Address - Fax:718-630-3761
Practice Address - Street 1:800 POLY PL
Practice Address - Street 2:MEDICAL SERVICE (111)
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-7104
Practice Address - Country:US
Practice Address - Phone:718-836-6600
Practice Address - Fax:718-630-3761
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2009-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY159661207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine