Provider Demographics
NPI:1003805763
Name:IBAY, ANNAMARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:ANNAMARIE
Middle Name:
Last Name:IBAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7000 ATRIUM WAY
Mailing Address - Street 2:SUITE 6
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-3917
Mailing Address - Country:US
Mailing Address - Phone:856-291-6818
Mailing Address - Fax:856-291-6819
Practice Address - Street 1:1636 ROUTE 38 AND EAYRESTOWN ROAD
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NJ
Practice Address - Zip Code:08048-0000
Practice Address - Country:US
Practice Address - Phone:609-914-8440
Practice Address - Fax:609-914-8441
Is Sole Proprietor?:No
Enumeration Date:2005-10-17
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07609100207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0042871Medicaid
NJ085541R63Medicare PIN
NJ0042871Medicaid
NJ085541YBAWMedicare PIN