Provider Demographics
NPI:1609896406
Name:KABAKIBI, RIAD AHMED (MD)
Entity Type:Individual
Prefix:DR
First Name:RIAD
Middle Name:AHMED
Last Name:KABAKIBI
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 1:255 STATE RT 3
Mailing Address - Street 2:SUITE206-A
Mailing Address - City:SECAUCUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07094-3857
Mailing Address - Country:US
Mailing Address - Phone:201-867-6677
Mailing Address - Fax:201-520-0316
Practice Address - Street 1:255 STATE RT 3
Practice Address - Street 2:SUITE206-A
Practice Address - City:SECAUCUS
Practice Address - State:NJ
Practice Address - Zip Code:07094-3857
Practice Address - Country:US
Practice Address - Phone:201-867-6677
Practice Address - Fax:201-520-0316
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA43227174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJC54671Medicare UPIN
NJKA444080Medicare ID - Type Unspecified