Healthcare Provider Details

I. General information

NPI: 1639605041
Provider Name (Legal Business Name): MICHEL SAMIR TERZIBACHI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2017
Last Update Date: 10/26/2023
Certification Date: 09/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 KALISA WAY SUITE 210
PARAMUS NJ
07652
US

IV. Provider business mailing address

1 KALISA WAY SUITE 210
PARAMUS NJ
07652
US

V. Phone/Fax

Practice location:
  • Phone: 201-447-0013
  • Fax: 201-255-4515
Mailing address:
  • Phone: 201-447-0013
  • Fax: 201-255-4515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number25MA10824300
License Number StateNJ

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: