Provider Demographics
NPI:1457633323
Name:GHABRIAL, AMGAD
Entity Type:Individual
Prefix:
First Name:AMGAD
Middle Name:
Last Name:GHABRIAL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:352 BROMLEY PL
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-5122
Mailing Address - Country:US
Mailing Address - Phone:908-420-9422
Mailing Address - Fax:732-969-1687
Practice Address - Street 1:352 BROMLEY PL
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-5122
Practice Address - Country:US
Practice Address - Phone:732-238-4410
Practice Address - Fax:732-969-1687
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-15
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02892600183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist