Healthcare Provider Details

I. General information

NPI: 1851331680
Provider Name (Legal Business Name): GEORGES A GHACIBEH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 12/15/2022
Certification Date: 12/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

381 PARK ST. SUITE 200
HACKENSACK NJ
07601-4350
US

IV. Provider business mailing address

381 PARK ST. SUITE 200
HACKENSACK NJ
07601-4350
US

V. Phone/Fax

Practice location:
  • Phone: 201-546-8510
  • Fax: 201-957-7316
Mailing address:
  • Phone: 201-546-8510
  • Fax: 201-957-7316

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084E0001X
TaxonomyEpilepsy Physician
License Number25MA08232000
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberME84939
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number25MA08232000
License Number StateNJ
# 4
Primary TaxonomyN
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License Number25MA08232000
License Number StateNJ
# 5
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number25MA08232000
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier269611800
Identifier TypeMEDICAID
Identifier StateFL
Identifier Issuer
# 2
Identifier0143731
Identifier TypeMEDICAID
Identifier StateNJ
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: