1225040397 NPI number — MARIAM GHOBRIEL M.D.

Table of content: MARIAM GHOBRIEL M.D. (NPI 1225040397)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225040397 NPI number — MARIAM GHOBRIEL M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GHOBRIEL
Provider First Name:
MARIAM
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1225040397
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/16/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
800 W MAIN ST
Provider Second Line Business Mailing Address:
111
Provider Business Mailing Address City Name:
FREEHOLD
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07728-2554
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-303-0102
Provider Business Mailing Address Fax Number:
732-637-8539

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
800 W MAIN ST
Provider Second Line Business Practice Location Address:
111
Provider Business Practice Location Address City Name:
FREEHOLD
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07728-2554
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-303-0102
Provider Business Practice Location Address Fax Number:
732-637-8539
Provider Enumeration Date:
08/13/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207LP2900X , with the licence number:  25MA007975600 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208VP0014X , with the licence number: 25MA07975600 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)