Provider Demographics
NPI:1881660959
Name:GIBBS, WILLIAM JR (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:
Last Name:GIBBS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7568 187TH ST
Mailing Address - Street 2:
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11366-1726
Mailing Address - Country:US
Mailing Address - Phone:718-969-7900
Mailing Address - Fax:718-969-7912
Practice Address - Street 1:7568 187TH ST
Practice Address - Street 2:
Practice Address - City:FRESH MEADOWS
Practice Address - State:NY
Practice Address - Zip Code:11366-1726
Practice Address - Country:US
Practice Address - Phone:718-969-7900
Practice Address - Fax:718-969-7912
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-27
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY226006208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02333517Medicaid
NY02333517Medicaid
NYG400001172Medicare PIN