Provider Demographics
NPI:1720057060
Name:SCIBILIA, GLENN DOUGLAS (MD)
Entity Type:Individual
Prefix:DR
First Name:GLENN
Middle Name:DOUGLAS
Last Name:SCIBILIA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:375 E MAIN ST
Mailing Address - Street 2:SUITE 24
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706
Mailing Address - Country:US
Mailing Address - Phone:631-665-1330
Mailing Address - Fax:631-665-1363
Practice Address - Street 1:375 E MAIN ST
Practice Address - Street 2:SUITE 24
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706
Practice Address - Country:US
Practice Address - Phone:631-665-1330
Practice Address - Fax:631-665-1363
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2012-10-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY190316207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01592429Medicaid
NY01592429Medicaid
G11473Medicare UPIN