Basic Information
| Provider Information | |||||||||
| NPI: | 1972588564 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TIBALDI | ||||||||
| FirstName: | JOSEPH | ||||||||
| MiddleName: | MICHAEL | ||||||||
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| Credential: | M.D.,F.A.C.P. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5945 161ST ST | ||||||||
| Address2: | |||||||||
| City: | FLUSHING | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113651414 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7187623111 | ||||||||
| FaxNumber: | 7183536315 | ||||||||
| Practice Location | |||||||||
| Address1: | 5945 161ST ST | ||||||||
| Address2: | |||||||||
| City: | FLUSHING | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113651414 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7187623111 | ||||||||
| FaxNumber: | 7183536315 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/07/2005 | ||||||||
| LastUpdateDate: | 10/07/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RE0101X | 144862 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism |
ID Information
| ID | Type | State | Issuer | Description | 0C3556 | 01 | NY | PHS | OTHER | 133442196 | 01 | NY | MAGNACARE | OTHER | DS054 | 01 | NY | OXFORD | OTHER | 133442196 | 01 | NY | UNITED HEALTH CARE | OTHER | JT023D8310 | 01 | NY | EMPIRE BLUE CROSS B/S | OTHER | 0460201011 | 01 | NY | CIGNA | OTHER | 166146 | 01 | NY | ELDERPLAN | OTHER | 28P0271 | 01 | NY | NEW YORK PRESBYTERIAN | OTHER |