Healthcare Provider Details

I. General information

NPI: 1699391839
Provider Name (Legal Business Name): ZIYODAKHON ABDUJABBOROVA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2020
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 N BROAD ST
PHILADELPHIA PA
19140-5103
US

IV. Provider business mailing address

451 CHESTNUT ST
AUDUBON NJ
08106-2122
US

V. Phone/Fax

Practice location:
  • Phone: 215-707-2000
  • Fax:
Mailing address:
  • Phone: 862-324-5210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMD480965
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: