Individual
EILEEN FARRELL GIBBONS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
235 BLUE POINT AVE, BLUE POINT, NY 11715-1261
(631) 363-5794
Mailing address
82 N HOWELLS POINT RD, BELLPORT, NY 11713-2313
(631) 807-9111
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
950373
NY
Other
Enumeration date
03/31/2022
Last updated
03/31/2022
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