Healthcare Provider Details

I. General information

NPI: 1073423893
Provider Name (Legal Business Name): IBRAHIM IBRAHIM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 NAZARETH PIKE
BETHLEHEM PA
18020-9080
US

IV. Provider business mailing address

224 NAZARETH PIKE
BETHLEHEM PA
18020-9080
US

V. Phone/Fax

Practice location:
  • Phone: 610-365-8373
  • Fax: 610-365-2522
Mailing address:
  • Phone: 610-365-8373
  • Fax: 610-365-2522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBH008764
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: