Individual
DAVID A KIBBY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
5719 WIDEWATERS PKWY, SYRACUSE, NY 13214-1985
(315) 251-3100
(315) 449-9923
Mailing address
5719 WIDEWATERS PKWY, SYRACUSE, NY 13214-1985
(315) 251-3100
(315) 449-9923
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
011985
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02925964
—
NY
01
—
J400002999
MEDICARE PTAN#
NY
Enumeration date
05/24/2007
Last updated
11/23/2011
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