Provider Demographics
NPI:1255535639
Name:SCIBELLI, CHRISTOPHER DAVID (MD)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:DAVID
Last Name:SCIBELLI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 LANSING ST
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:NY
Mailing Address - Zip Code:13021-1983
Mailing Address - Country:US
Mailing Address - Phone:315-255-7011
Mailing Address - Fax:315-255-7289
Practice Address - Street 1:17 LANSING ST STE 302
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:NY
Practice Address - Zip Code:13021-1983
Practice Address - Country:US
Practice Address - Phone:315-567-0540
Practice Address - Fax:315-567-0334
Is Sole Proprietor?:No
Enumeration Date:2007-06-12
Last Update Date:2025-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010544292086S0129X
NY2791352086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04176550Medicaid
NYJ400237061Medicare PIN