Provider Demographics
NPI:1275748261
Name:GARUBA, MARIAM IHUOMAKANWA (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIAM
Middle Name:IHUOMAKANWA
Last Name:GARUBA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:35 JOURNAL SQUARE PLAZA
Mailing Address - Street 2:# 486
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-2054
Mailing Address - Country:US
Mailing Address - Phone:862-902-9798
Mailing Address - Fax:731-225-8250
Practice Address - Street 1:451 CLARKSON AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-2054
Practice Address - Country:US
Practice Address - Phone:718-245-2310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1068672084P0800X
CAC1721912084P0800X
MDD00907752084P0800X
NY2681532084P0800X
NJ25MA097896002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry