Provider Demographics
NPI:1679356216
Name:SIBTAIN, TABINA
Entity type:Individual
Prefix:
First Name:TABINA
Middle Name:
Last Name:SIBTAIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26101 E WILLISTON AVE
Mailing Address - Street 2:
Mailing Address - City:FLORAL PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11001-1144
Mailing Address - Country:US
Mailing Address - Phone:832-322-2896
Mailing Address - Fax:
Practice Address - Street 1:8345 LANGDALE ST
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040-1822
Practice Address - Country:US
Practice Address - Phone:718-470-0208
Practice Address - Fax:718-470-0239
Is Sole Proprietor?:No
Enumeration Date:2023-08-16
Last Update Date:2023-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY070600183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist