Provider Demographics
NPI:1437802568
Name:GHOBREAL, BEMIN (PHD)
Entity Type:Individual
Prefix:DR
First Name:BEMIN
Middle Name:
Last Name:GHOBREAL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2845 SPRUCE ST APT 3
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-6483
Mailing Address - Country:US
Mailing Address - Phone:856-803-6903
Mailing Address - Fax:
Practice Address - Street 1:2845 SPRUCE ST APT 3
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-6483
Practice Address - Country:US
Practice Address - Phone:856-803-6903
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-29
Last Update Date:2022-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ31D2244031291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory