Travis Lawrence Gibson, D.M.D

Primary specialty

Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X

License

058591-1 Issued in NY

Practice address

550 1St Ave
NYU Langone Medical Center
New York, NY 10016-6402

Phone

(212) 263-5506

NPI assigned

Aug 10, 2016

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1470787200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1470787200000",
    "number": "1831643691",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "531 E 20TH ST",
            "address_2": "UNIT 11A",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100107602",
            "telephone_number": "917-519-3413"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "550 1ST AVE",
            "address_2": "NYU LANGONE MEDICAL CENTER",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100166402",
            "telephone_number": "212-263-5506"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GIBSON",
        "first_name": "TRAVIS",
        "middle_name": "LAWRENCE",
        "name_prefix": "Dr.",
        "credential": "D.M.D",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-08-10",
        "last_updated": "2016-08-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NY",
            "license": "058591-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Monique Gibson, M.S.
• Patrice-Lou Gibson, RN, BSN
• Russell Wayne Gibson, M.D.
• Sakai Symone Gibson
• Tex Marie Gibson, LMSW
• Alexander Ross Gibstein, MD, MBA
• Danvas Bogonko Gichana
• Adi Gidali, DPT
• Helen Gidali
• Dylan Gidanian

• Student in an Organized Health Care Education/Training Program in New York, NY
• Providers in New York, NY by specialty
• Student in an Organized Health Care Education/Training Program in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.