Provider Demographics
NPI:1225124613
Name:DIB, HAITHAM R (MD)
Entity Type:Individual
Prefix:DR
First Name:HAITHAM
Middle Name:R
Last Name:DIB
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:436 CHRIS GAUPP DR
Mailing Address - Street 2:STE 204
Mailing Address - City:GALLOWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08205-4487
Mailing Address - Country:US
Mailing Address - Phone:609-652-0100
Mailing Address - Fax:609-652-7616
Practice Address - Street 1:436 CHRIS GAUPP DR
Practice Address - Street 2:STE 204
Practice Address - City:GALLOWAY
Practice Address - State:NJ
Practice Address - Zip Code:08205-4487
Practice Address - Country:US
Practice Address - Phone:609-652-0100
Practice Address - Fax:609-652-7616
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2014-04-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA05648300207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ088567SHDMedicare PIN
NJF27279Medicare UPIN
NJ029698CN9Medicare PIN