Provider Demographics
NPI:1235918814
Name:IBRAHIM, EHAB (SOLE PROVIDER)
Entity Type:Individual
Prefix:
First Name:EHAB
Middle Name:
Last Name:IBRAHIM
Suffix:
Gender:M
Credentials:SOLE PROVIDER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 MUNDY AVE
Mailing Address - Street 2:
Mailing Address - City:SPOTSWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08884-1749
Mailing Address - Country:US
Mailing Address - Phone:201-285-9729
Mailing Address - Fax:
Practice Address - Street 1:72 MUNDY AVE
Practice Address - Street 2:
Practice Address - City:SPOTSWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08884-1749
Practice Address - Country:US
Practice Address - Phone:201-285-9729
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-25
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No347C00000XTransportation ServicesPrivate Vehicle