Provider Demographics
NPI:1528012564
Name:GARIB, JORGE L (MD)
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:L
Last Name:GARIB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:E12 CALLE MALAGA
Mailing Address - Street 2:VISTAMAR MARINA ESTE
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00983-1507
Mailing Address - Country:US
Mailing Address - Phone:787-752-0639
Mailing Address - Fax:787-721-1684
Practice Address - Street 1:E12 CALLE MALAGA
Practice Address - Street 2:VISTAMAR MARINA ESTE
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00983-1507
Practice Address - Country:US
Practice Address - Phone:787-752-0639
Practice Address - Fax:787-721-1684
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04500800207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRC-78197Medicare UPIN