Provider Demographics
NPI:1184795569
Name:GIBBS, KAREN E (MD)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:E
Last Name:GIBBS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 POST RD STE 101
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-5730
Mailing Address - Country:US
Mailing Address - Phone:203-418-9520
Mailing Address - Fax:
Practice Address - Street 1:256 MASON AVENUE, BLDG B
Practice Address - Street 2:UNITED MEDICAL SURGICAL, PC
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305
Practice Address - Country:US
Practice Address - Phone:718-226-1300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY215106208600000X
CT69032208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400025663Medicare PIN