Provider Demographics
NPI:1205067774
Name:SANDRA GILBAN MD PC
Entity type:Organization
Organization Name:SANDRA GILBAN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:GILBAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-743-6838
Mailing Address - Street 1:125 E 87TH ST APT 4D
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-1125
Mailing Address - Country:US
Mailing Address - Phone:917-743-6838
Mailing Address - Fax:212-288-7735
Practice Address - Street 1:911 PARK AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10075-0385
Practice Address - Country:US
Practice Address - Phone:212-288-7388
Practice Address - Fax:212-288-7735
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-02
Last Update Date:2009-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY206109261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG55296Medicare UPIN