Healthcare Provider Details

I. General information

NPI: 1447251764
Provider Name (Legal Business Name): NIBAL AHMAD ZAGHLOUL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 12/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

254 EASTON AVE
NEW BRUNSWICK NJ
08901-1766
US

IV. Provider business mailing address

254 EASTON AVE
NEW BRUNSWICK NJ
08901-1766
US

V. Phone/Fax

Practice location:
  • Phone: 732-745-6674
  • Fax: 732-418-9708
Mailing address:
  • Phone: 732-745-6674
  • Fax: 732-418-9708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number35086391
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number25MA08840100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: