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General NPI Number Information
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NPI Number | 1669633558
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Entity Type | Individual
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Provider Name | MAHMUD IBRAHIM M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/23/2008
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Last Update Date | 06/09/2022
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Provider Practice Location Address
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Address Line | 555 ROUTE 18 STE 202
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City | EAST BRUNSWICK
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State | NJ
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Zip | 08816-3727
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Country | US
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Telephone | 732-955-9139
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Fax | 732-387-8594
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Provider Business Mailing Address
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Address Line | 555 ROUTE 18 STE 202
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City | EAST BRUNSWICK
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State | NJ
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Zip | 08816-3727
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Country | US
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Telephone | 732-955-9139
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Fax | 732-387-8594
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2081S0010X
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Taxonomy Name | Sports Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | 25MA09258600
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License Number State | NJ
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