Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | ME131734 | FL |
NPI | 1447559026 |
---|---|
Provider Name | Dr. Gregory Scott Dibelius |
First Address | New York, NY 10022-1009 |
Second Address | Jamaica, NY 11418-2828 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2011 |
Last Update Date | 02/12/2021 |