Provider Demographics
NPI:1083238422
Name:IGIEBOR, FRANK
Entity Type:Individual
Prefix:
First Name:FRANK
Middle Name:
Last Name:IGIEBOR
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 1:27 LARK DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08882-2605
Mailing Address - Country:US
Mailing Address - Phone:917-449-8183
Mailing Address - Fax:
Practice Address - Street 1:27 LARK DR
Practice Address - Street 2:
Practice Address - City:SOUTH RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08882-2605
Practice Address - Country:US
Practice Address - Phone:917-449-8183
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-02
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJI30872670007692372500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider