Healthcare Provider Details

I. General information

NPI: 1437012846
Provider Name (Legal Business Name): CHAMSEDDINE JEBALI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/03/2025
Last Update Date: 12/03/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

279 BROADWAY
LONG BRANCH NJ
07740-6940
US

IV. Provider business mailing address

279 BROADWAY
LONG BRANCH NJ
07740-6940
US

V. Phone/Fax

Practice location:
  • Phone: 732-500-0993
  • Fax:
Mailing address:
  • Phone: 732-500-0993
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code344600000X
TaxonomyTaxi
License Number
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: