Healthcare Provider Details

I. General information

NPI: 1538428677
Provider Name (Legal Business Name): BADRELDIN ABDELRAHMAN M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2012
Last Update Date: 04/26/2024
Certification Date: 04/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

355 GRAND ST NICU
JERSEY CITY MEDICAL CENTER NJ
07302
US

IV. Provider business mailing address

840S WOOD ST 1262
CHICAGO IL
60612-4325
US

V. Phone/Fax

Practice location:
  • Phone: 201-915-2330
  • Fax: 201-915-2705
Mailing address:
  • Phone: 312-996-4185
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number25MA10363300
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MA10363300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: