Provider Demographics
NPI:1508536491
Name:ISMAILOFF, GUNAY IBRAHIM
Entity Type:Individual
Prefix:
First Name:GUNAY
Middle Name:IBRAHIM
Last Name:ISMAILOFF
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 1:27 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07011-1606
Mailing Address - Country:US
Mailing Address - Phone:551-206-0517
Mailing Address - Fax:
Practice Address - Street 1:160 KINGSLAND RD
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07014-1915
Practice Address - Country:US
Practice Address - Phone:973-779-7831
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-14
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI04200800183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist