Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Jaclyn Mary Dibello

Individual provider Emergency Medicine Physician · NPI 1154061638

Jaclyn Mary Dibello is an Emergency Medicine in Staten Island, New York. Graduated from State University of New York at Stony Brook, School of Medicine in 2022, 4 years ago. Practices with North Shore-Lij Medical PC, a 6,350-clinician group and accepts Medicare assignment. Licensed in New York.

Years since qualifying
4
Trained at
State University of New York at Stony Brook, School of Medicine
Licensed in
NY
In the registry since
2022
Claim this listing Report a problem Suggest an edit

Practice location Address checks out

475 Seaview Ave
Staten Island, NY 10305-3436
Phone: (718) 226-1548
Fax: (718) 226-8447
Show map & directions

Directions in Google Maps · Apple Maps · OpenStreetMap

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Emergency Medicine Physician (primary) Taxonomy 207P00000X · Licence 335570-01 (NY)

Record details

NPI number1154061638
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedMarch 31, 2022
Last updated in NPPESAugust 27, 2025
Certification dateAugust 27, 2025
Mailing address475 Seaview Ave, Staten Island, NY 10305-3436

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyEMERGENCY MEDICINE
Medical schoolSTATE UNIVERSITY OF NEW YORK AT STONY BROOK, SCHOOL OF MEDICINE
Graduated 2022 (4 years in practice)
Group practice North Shore-Lij Medical Pc — 6350 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

Other providers in Staten Island