1932163342 NPI number — DR. JENNIFER IBRAHIM M.D.

Table of content: DR. JENNIFER IBRAHIM M.D. (NPI 1932163342)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932163342 NPI number — DR. JENNIFER IBRAHIM M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
IBRAHIM
Provider First Name:
JENNIFER
Provider Middle Name:
Provider Name Prefix Text:
DR.
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:
1932163342
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
34 E BROAD ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BERGENFIELD
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07621-3004
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-387-1033
Provider Business Mailing Address Fax Number:
201-503-1029

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
350 ENGLE ST
Provider Second Line Business Practice Location Address:
2 E
Provider Business Practice Location Address City Name:
ENGLEWOOD
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07631-1808
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-227-5526
Provider Business Practice Location Address Fax Number:
201-503-1029
Provider Enumeration Date:
04/13/2006

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: 207SG0201X , with the licence number:  MA71003 , 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)

  • Identifier: 8628853 . This is a "CIGNA-SJMC" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 3609213 . This is a "AETNA-SJMC" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 2K5382 . This is a "HEALTHNET-SJMC" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 8333301 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: P3168033 . This is a "OXFORD-SJMC" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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