Provider Demographics
NPI:1972588564
Name:TIBALDI, JOSEPH MICHAEL (MD,FACP)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:MICHAEL
Last Name:TIBALDI
Suffix:
Gender:M
Credentials:MD,FACP
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Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:17415 HORACE HARDING EXPY FL 2
Mailing Address - Street 2:
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11365-1527
Mailing Address - Country:US
Mailing Address - Phone:718-762-3111
Mailing Address - Fax:718-353-6315
Practice Address - Street 1:17415 HORACE HARDING EXPY FL 2
Practice Address - Street 2:
Practice Address - City:FRESH MEADOWS
Practice Address - State:NY
Practice Address - Zip Code:11365-1527
Practice Address - Country:US
Practice Address - Phone:718-762-3111
Practice Address - Fax:718-353-6315
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY144862207RE0101X
NYAT1048188207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY133442196OtherUNITED HEALTH CARE
NY133442196OtherMAGNACARE
NY0460201011OtherCIGNA
NYDS054OtherOXFORD
NYJT023D8310OtherEMPIRE BLUE CROSS B/S
NY28P0271OtherNEW YORK PRESBYTERIAN
NY0C3556OtherPHS
NY166146OtherELDERPLAN
NYB88629Medicare UPIN
NY0C3556OtherPHS