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Individual

COLLEEN MCGIBNEY

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
MS, RD, CDN

Contact information

Practice address
11 SCHENCK AVE APT 3D, GREAT NECK, NY 11021-3606
(631) 375-4628
Mailing address
11 SCHENCK AVE APT 3D, GREAT NECK, NY 11021-3606
(631) 375-4628

Taxonomy

Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
86060497
133VN1006X
Metabolic Nutrition Registered Dietitian
86060497

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
009893
NEW YORK STATE REGISTRATION
NY
01
4945019
CIGNA
Enumeration date
07/19/2019
Last updated
12/18/2023
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