Individual
TIA GIBBS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
21623 132ND RD, JAMAICA, NY 11413-1516
(516) 435-1017
Mailing address
21623 132ND RD, JAMAICA, NY 11413-1516
(516) 435-1017
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Enumeration date
02/02/2026
Last updated
02/02/2026
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