| Doctor Name: | MR. MICHAEL JOSEPH GIBBONS |
| NPI Number: | 1083895999 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | RN |
| License Number: | 4501131 |
| Business Practice Address: | 12 Scenic Hills Dr Ridge, NY - 119613022 |
| Business Phone Number: | 6317759317 |
| Business Fax Number: | |
| Mailing Address: | 12 Scenic Hills Dr, RIDGE |
| State: | NY |
| Postal Code: | 119613022 |
| Phone Number: | 6317759317 |
| Fax Number: | |
| NPI Enumeration Date: | 11/19/2007 |
| NPI Last Update Date: | 11/19/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 163WH0200X |
| License Number: | 4501131 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Registered Nurse |
| Taxonomy Specialization: | Home Health |
| Taxonomy Definition: | |