Healthcare Provider Details

I. General information

NPI: 1962713040
Provider Name (Legal Business Name): NANCY IBRAHIM M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2010
Last Update Date: 12/30/2025
Certification Date: 12/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 E JIMMIE LEEDS RD STE 101
GALLOWAY NJ
08205-9599
US

IV. Provider business mailing address

8025 BLACK HORSE PIKE
PLEASANTVILLE NJ
08232-2900
US

V. Phone/Fax

Practice location:
  • Phone: 609-677-9729
  • Fax:
Mailing address:
  • Phone: 609-652-8316
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberMT198144
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number25MA09843600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: