Provider Demographics
NPI:1871033985
Name:SUKHREET BIBBS
Entity Type:Organization
Organization Name:SUKHREET BIBBS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PRACTICAL NURSE
Authorized Official - Prefix:
Authorized Official - First Name:SUKHREET
Authorized Official - Middle Name:M E
Authorized Official - Last Name:BIBBS
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:315-294-4558
Mailing Address - Street 1:1 BRADFORD CT
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13207-2504
Mailing Address - Country:US
Mailing Address - Phone:315-294-4558
Mailing Address - Fax:
Practice Address - Street 1:1 BRADFORD CT
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13207-2504
Practice Address - Country:US
Practice Address - Phone:315-294-4558
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-08
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3280643140N1450X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3140N1450XNursing & Custodial Care FacilitiesSkilled Nursing FacilityNursing Care, Pediatric