Provider Demographics
NPI:1881048569
Name:SIMBANA, CARLOS TIBERIO
Entity type:Individual
Prefix:MR
First Name:CARLOS
Middle Name:TIBERIO
Last Name:SIMBANA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8006 101 AVENUE
Mailing Address - Street 2:
Mailing Address - City:OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11416
Mailing Address - Country:US
Mailing Address - Phone:718-659-5501
Mailing Address - Fax:718-848-2622
Practice Address - Street 1:8006 101ST AVE
Practice Address - Street 2:
Practice Address - City:OZONE PARK
Practice Address - State:NY
Practice Address - Zip Code:11416-1939
Practice Address - Country:US
Practice Address - Phone:718-659-5501
Practice Address - Fax:718-848-2622
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-19
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYB02903344600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes344600000XTransportation ServicesTaxi