Provider Demographics
NPI:1508025834
Name:IBRAHIM, AYMAN M (DO)
Entity Type:Individual
Prefix:DR
First Name:AYMAN
Middle Name:M
Last Name:IBRAHIM
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:370 W PLEASANTVIEW AVE
Mailing Address - Street 2:SUITE 2-299
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-8004
Mailing Address - Country:US
Mailing Address - Phone:973-680-8400
Mailing Address - Fax:973-680-8404
Practice Address - Street 1:194 BROAD ST
Practice Address - Street 2:SUITE 4
Practice Address - City:BLOOMFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07003-2606
Practice Address - Country:US
Practice Address - Phone:973-680-8400
Practice Address - Fax:973-680-8404
Is Sole Proprietor?:No
Enumeration Date:2008-06-02
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN02003764A2084N0400X
NJ25MB093962002084N0400X
NY2595902084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0397261Medicaid
INM400050665OtherMEDICARE PTAN