Healthcare Provider Details

I. General information

NPI: 1801846597
Provider Name (Legal Business Name): LABIB E. RIACHI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 05/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 WILLIAMSON ST SUITE 304
ELIZABETH NJ
07202-3674
US

IV. Provider business mailing address

240 WILLIAMSON ST SUITE 304
ELIZABETH NJ
07202-3674
US

V. Phone/Fax

Practice location:
  • Phone: 908-282-2000
  • Fax: 908-282-6660
Mailing address:
  • Phone: 908-282-2000
  • Fax: 908-282-6660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number25MA07007000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: