Provider Demographics
NPI:1568494961
Name:ADIBE, SEBASTIAN O (MD)
Entity Type:Individual
Prefix:DR
First Name:SEBASTIAN
Middle Name:O
Last Name:ADIBE
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 1:142 PALISADE AVE
Mailing Address - Street 2:SUITE 212
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-1133
Mailing Address - Country:US
Mailing Address - Phone:201-792-1555
Mailing Address - Fax:201-792-1030
Practice Address - Street 1:142 PALISADE AVE
Practice Address - Street 2:SUITE 212
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-1133
Practice Address - Country:US
Practice Address - Phone:201-792-1555
Practice Address - Fax:201-792-1030
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03273600174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ085 9303Medicaid
NJ085 9303Medicaid
NJC53471Medicare UPIN