Provider Demographics
NPI:1003594334
Name:ZONGO, IBARHIM
Entity Type:Individual
Prefix:
First Name:IBARHIM
Middle Name:
Last Name:ZONGO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 EVELYN CT
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07040-3319
Mailing Address - Country:US
Mailing Address - Phone:862-256-9237
Mailing Address - Fax:
Practice Address - Street 1:2 EVELYN CT
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07040-3319
Practice Address - Country:US
Practice Address - Phone:862-256-9237
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-07
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJZ64053540003922171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor