Provider Demographics
NPI:1871018549
Name:GIBBS, ANGELA (CPCP)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:GIBBS
Suffix:
Gender:F
Credentials:CPCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 PRINCE AVE
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11520-1022
Mailing Address - Country:US
Mailing Address - Phone:347-881-6767
Mailing Address - Fax:
Practice Address - Street 1:206 LIVINGSTON ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-5811
Practice Address - Country:US
Practice Address - Phone:516-939-4752
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-03
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist