Provider Demographics
NPI:1891356242
Name:GILBANE, MAX (AUD)
Entity Type:Individual
Prefix:
First Name:MAX
Middle Name:
Last Name:GILBANE
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:716 N 3RD ST # 3R
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19123-2904
Mailing Address - Country:US
Mailing Address - Phone:510-703-3776
Mailing Address - Fax:
Practice Address - Street 1:1941 LIMESTONE RD STE 210
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-5400
Practice Address - Country:US
Practice Address - Phone:302-998-0300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-26
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEO2-0000251231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist