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General NPI Number Information
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NPI Number | 1932163342
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Entity Type | Individual
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Provider Name | JENNIFER IBRAHIM M.D.
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Gender | Female
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Dates
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Enumeration Date | 04/13/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 350 ENGLE ST 2 E
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City | ENGLEWOOD
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State | NJ
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Zip | 07631-1808
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Country | US
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Telephone | 201-227-5526
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Fax | 201-503-1029
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Provider Business Mailing Address
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Address Line | 34 E BROAD ST
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City | BERGENFIELD
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State | NJ
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Zip | 07621-3004
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Country | US
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Telephone | 201-387-1033
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Fax | 201-503-1029
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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 | 207SG0201X
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Taxonomy Name | Clinical Genetics (M.D.) Physician
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License Number | MA71003
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License Number State | NJ
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