Provider Demographics
NPI:1144381005
Name:KARABACH, MAXIM (MD)
Entity Type:Individual
Prefix:MR
First Name:MAXIM
Middle Name:
Last Name:KARABACH
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 1:67 LACEY RD.
Mailing Address - Street 2:STE 5
Mailing Address - City:WHITING
Mailing Address - State:NJ
Mailing Address - Zip Code:08759-2354
Mailing Address - Country:US
Mailing Address - Phone:732-716-1700
Mailing Address - Fax:732-716-0500
Practice Address - Street 1:67 LACEY RD.
Practice Address - Street 2:STE 5
Practice Address - City:WHITING
Practice Address - State:NJ
Practice Address - Zip Code:08759-2354
Practice Address - Country:US
Practice Address - Phone:732-716-1700
Practice Address - Fax:732-716-0500
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA66521207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7399308Medicaid
NJ223740941OtherTAX ID
NJ223740941Medicaid
NJ7399308Medicaid