Provider Demographics
NPI:1679546055
Name:GIBRALTER, RICHARD P (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:P
Last Name:GIBRALTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:154 EAST 71ST. ST.
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021
Mailing Address - Country:US
Mailing Address - Phone:212-628-2202
Mailing Address - Fax:212-879-5439
Practice Address - Street 1:154 E 71ST ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-5125
Practice Address - Country:US
Practice Address - Phone:212-628-2202
Practice Address - Fax:212-879-5439
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY131814207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
B11969Medicare UPIN
NY27A561Medicare ID - Type Unspecified