Individual
MRS. ANDREA JO GIBBONS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
R.P.A.-C.
Contact information
Practice address
1175 MONTAUK HWY, SUITE 4, WEST ISLIP, NY 11795-4939
(631) 422-9600
Mailing address
21 WENMAN AVE, BAY SHORE, NY 11706-8923
(631) 665-8034
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
008888
NY
Other
Enumeration date
12/12/2006
Last updated
11/22/2014
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