Individual ProviderBlaine Duval GibbsSpecialistOther Service ProvidersPractice Address329 E 149th St Fl 4, Bronx, NY 10451-5626(718) 769-2698(646) 837-4005PECOS EnrollmentBased on the most recent information from CMS, provider Blaine Duval Gibbs does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 8:41 AM.Profile DetailsProvider ID1912421322Provider TypeIndividualFull NameGibbs, Blaine DuvalTitleMr.CredentialABA THERAPISTGenderMaleSole ProprietorNoEnumeration Date7/27/2017Last Updated7/27/2017Contact InformationPractice LocationPractice Address329 E 149th St Fl 4, Bronx, NY 10451-5626Phone(718) 769-2698FaxUnlisted FaxMailing LocationMailing Address1135 University Ave Apt 1f, Bronx, NY 10452-4236Phone(646) 837-4005FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode174400000XPrimaryDescriptionSpecialistOther Service ProvidersLicenseUnlisted IssuerNew York