Healthcare Provider Details

I. General information

NPI: 1063367316
Provider Name (Legal Business Name): RABIATU BRAIMAH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2026
Last Update Date: 03/02/2026
Certification Date: 03/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1680 N OLDEN AVE
EWING NJ
08638-3209
US

IV. Provider business mailing address

1680 N OLDEN AVE
EWING NJ
08638-3209
US

V. Phone/Fax

Practice location:
  • Phone: 609-749-6180
  • Fax:
Mailing address:
  • Phone: 609-749-6180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number25MP00990600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: