Provider Demographics
NPI:1275571515
Name:ABUBAKAR, TUNKU ABDUL RAHMAN BEN (MD)
Entity Type:Individual
Prefix:
First Name:TUNKU
Middle Name:ABDUL RAHMAN BEN
Last Name:ABUBAKAR
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 1:2 GRIFFIN WAY
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-6125
Mailing Address - Country:US
Mailing Address - Phone:609-936-9493
Mailing Address - Fax:
Practice Address - Street 1:2 GRIFFIN WAY
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-6125
Practice Address - Country:US
Practice Address - Phone:609-936-9493
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-02
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2221972084P0800X
NJ25MA060813002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJG07510Medicare UPIN
NJ036203Medicare ID - Type Unspecified