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General NPI Number Information
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NPI Number | 1922591783
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Entity Type | Individual
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Provider Name | MARLY JIBY
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Gender | Female
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Dates
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Enumeration Date | 06/07/2018
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Last Update Date | 07/26/2024
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Provider Practice Location Address
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Address Line | 18 COURT ST
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City | FLEMINGTON
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State | NJ
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Zip | 08822-2139
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Country | US
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Telephone | 914-573-1617
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Fax |
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Provider Business Mailing Address
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Address Line | 112 ROBIN WAY
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City | NESHANIC STATION
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State | NJ
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Zip | 08853-3609
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Country | US
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Telephone |
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Fax |
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 26NJ00825700
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License Number State | NJ
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