Provider Demographics
NPI:1093709529
Name:IBRAHIM, ADEL (MD)
Entity Type:Individual
Prefix:DR
First Name:ADEL
Middle Name:
Last Name:IBRAHIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:551 NEWMAN SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:LINCROFT
Mailing Address - State:NJ
Mailing Address - Zip Code:07738-1472
Mailing Address - Country:US
Mailing Address - Phone:732-530-9200
Mailing Address - Fax:732-530-8820
Practice Address - Street 1:551 NEWMAN SPRINGS RD
Practice Address - Street 2:
Practice Address - City:LINCROFT
Practice Address - State:NJ
Practice Address - Zip Code:07738-1472
Practice Address - Country:US
Practice Address - Phone:732-530-9200
Practice Address - Fax:732-530-8820
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-12
Last Update Date:2011-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05686900207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6681905Medicaid
NJ800088P7GMedicare PIN
NJ6681905Medicaid
NJ800088UWYMedicare PIN
NJ800088MK3Medicare PIN
NJ800088UXLMedicare PIN
NJ800088Medicare ID - Type Unspecified
NJ800088DPHMedicare PIN