Active NPI
Paul A Gibilisco, MD
- Rheumatology Physician
- Norfolk, CT
National Provider Identifier
1013040401
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Rheumatology Physician
- License
- 023213
- Practice address
- 72 Shepard Rd
Norfolk, CT 06058-1125 - Phone
- (860) 542-5643
- NPI assigned
- Mar 14, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rheumatology Physician | 207RR0500X | 023213 | CT | Primary |
Addresses
Primary practice location
72 Shepard Rd
Norfolk, CT 06058-1125
Mailing address
72 Shepard Rd
Norfolk, CT 06058-1125
Phone (860) 542-5643
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 023213 | CT | MD | Rheumatology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173830400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1013040401",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "72 SHEPARD RD",
"city": "NORFOLK",
"state": "CT",
"postal_code": "060581125",
"telephone_number": "860-542-5643"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "72 SHEPARD RD",
"city": "NORFOLK",
"state": "CT",
"postal_code": "060581125",
"telephone_number": "860-542-5643"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GIBILISCO",
"first_name": "PAUL",
"middle_name": "A",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-03-14",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "207RR0500X",
"taxonomy_group": "",
"desc": "Internal Medicine, Rheumatology",
"state": "CT",
"license": "023213",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Norfolk, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.