Active NPI
Cynthia Kibiuk, DDS
- Dentist
- New Hartford, NY
National Provider Identifier
1710017694
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 042837-1
- Practice address
- 2050 Tilden Ave
Box 1000
New Hartford, NY 13413-3613 - Phone
- (315) 797-3114
- Fax
- (315) 624-0474
- NPI assigned
- Mar 7, 2007
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | 042837-1 | NY | Primary |
Addresses
Primary practice location
2050 Tilden Ave
Box 1000
New Hartford, NY 13413-3613
Mailing address
10843 N Gage Rd
Barneveld, NY 13304-2530
Phone (315) 797-3114
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NY
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150625001449 | NY | Order and Referring Only - Oral Surgery | 0648581074 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 042837-1 | NY | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173225600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1710017694",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10843 N GAGE RD",
"city": "BARNEVELD",
"state": "NY",
"postal_code": "133042530",
"telephone_number": "315-797-3114"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2050 TILDEN AVE",
"address_2": "BOX 1000",
"city": "NEW HARTFORD",
"state": "NY",
"postal_code": "134133613",
"telephone_number": "315-797-3114",
"fax_number": "315-624-0474"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIBIUK",
"first_name": "CYNTHIA",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-03-07",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NY",
"license": "042837-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in New Hartford, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.