Active NPI
Keith Jerry Vibert, DDS
- Dentist
- Stony Brook, NY
National Provider Identifier
1881911063
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 055638
- Practice address
- Stony Brook University Hospital
Medical Staff Office T9
Stony Brook, NY 11794-7097 - Phone
- (631) 444-2754
- Fax
- (631) 444-6031
- NPI assigned
- Apr 27, 2010
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | 055638 | NY | Primary |
Addresses
Primary practice location
Stony Brook University Hospital
Medical Staff Office T9
Stony Brook, NY 11794-7097
Mailing address
Stony Brook University Hospital
Medical Staff Office T9
Stony Brook, NY 11794-7097
Phone (631) 444-2754
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 055638 | NY | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1272326400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1699833600000",
"number": "1881911063",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "STONY BROOK UNIVERSITY HOSPITAL",
"address_2": "MEDICAL STAFF OFFICE T9",
"city": "STONY BROOK",
"state": "NY",
"postal_code": "117947097",
"telephone_number": "631-444-2754",
"fax_number": "631-444-6031"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "STONY BROOK UNIVERSITY HOSPITAL",
"address_2": "MEDICAL STAFF OFFICE T9",
"city": "STONY BROOK",
"state": "NY",
"postal_code": "117947097",
"telephone_number": "631-444-2754",
"fax_number": "631-444-6031"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VIBERT",
"first_name": "KEITH",
"middle_name": "JERRY",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2010-04-27",
"last_updated": "2023-11-13",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NY",
"license": "055638",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Stony Brook, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.