Provider Demographics
NPI:1164812954
Name:IBRAHIMOVIC, ENIDA
Entity Type:Individual
Prefix:
First Name:ENIDA
Middle Name:
Last Name:IBRAHIMOVIC
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5548 BEAR RD APT 14B
Mailing Address - Street 2:
Mailing Address - City:NORTH SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13212-1414
Mailing Address - Country:US
Mailing Address - Phone:315-807-1767
Mailing Address - Fax:
Practice Address - Street 1:5548 BEAR RD APT 14B
Practice Address - Street 2:
Practice Address - City:NORTH SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13212-1414
Practice Address - Country:US
Practice Address - Phone:315-807-1767
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-31
Last Update Date:2015-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)