Healthcare Provider Details

I. General information

NPI: 1457633323
Provider Name (Legal Business Name): AMGAD GHABRIAL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2011
Last Update Date: 09/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

352 BROMLEY PL
EAST BRUNSWICK NJ
08816-5122
US

IV. Provider business mailing address

352 BROMLEY PL
EAST BRUNSWICK NJ
08816-5122
US

V. Phone/Fax

Practice location:
  • Phone: 732-238-4410
  • Fax: 732-969-1687
Mailing address:
  • Phone: 908-420-9422
  • Fax: 732-969-1687

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI02892600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: