Active NPI
Raffaele A Gibilisco, MD, PA
- Gastroenterology Physician
- West New York, NJ
National Provider Identifier
1124134002
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Gastroenterology Physician
- License
- MA060124
- Practice address
- 435 59TH St
1St Floor
West New York, NJ 07093-2107 - Phone
- (201) 295-1456
- Fax
- (201) 295-0266
- NPI assigned
- Aug 22, 2006
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Gastroenterology Physician | 207RG0100X | MA060124 | NJ | Primary |
Addresses
Primary practice location
435 59TH St
1St Floor
West New York, NJ 07093-2107
Mailing address
PO Box 4067
Warren, NJ 07059-0067
Phone (201) 295-1456
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 6057608 | Medicaid | NJ |
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)
- Enrolled
- Credentials
- Doctor of Medicine, Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MA060124 | NJ | MD | Gastroenterology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Humc Opco LLC | Current | Accepting new patients | |
| Medical Associates of Englewood, PC | Past | Accepting new patients |
Interoperability endpoints
- raffaele.gibilisco@direct.hobokenumc.md
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- General Acute Care Hospital
- Hoboken, NJ
- NPI 1043475668
-
- Internal Medicine Physician
- Englewood, NJ
- NPI 1952681918
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156204800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1436832000000",
"number": "1124134002",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 4067",
"city": "WARREN",
"state": "NJ",
"postal_code": "070590067",
"telephone_number": "201-295-1456",
"fax_number": "201-295-0266"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "435 59TH ST",
"address_2": "1ST FLOOR",
"city": "WEST NEW YORK",
"state": "NJ",
"postal_code": "070932107",
"telephone_number": "201-295-1456",
"fax_number": "201-295-0266"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GIBILISCO",
"first_name": "RAFFAELE",
"middle_name": "A",
"name_prefix": "Dr.",
"credential": "MD, PA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-22",
"last_updated": "2015-07-14",
"status": "A"
},
"taxonomies": [
{
"code": "207RG0100X",
"taxonomy_group": "",
"desc": "Internal Medicine, Gastroenterology",
"state": "NJ",
"license": "MA060124",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "6057608",
"state": "NJ"
}
],
"endpoints": [],
"other_names": []
}Other providers in West New York, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.