Provider Demographics
NPI:1639201510
Name:DARBOUZE, JEAN ROBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:JEAN
Middle Name:ROBERT
Last Name:DARBOUZE
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 1:230 BERGEN AVE
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07305-1522
Mailing Address - Country:US
Mailing Address - Phone:201-833-3948
Mailing Address - Fax:201-833-2513
Practice Address - Street 1:230 BERGEN AVE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07305-1522
Practice Address - Country:US
Practice Address - Phone:201-432-0809
Practice Address - Fax:201-432-0074
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05886000174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ110186731Medicaid
NY$$$$$$$$$OtherSSN
NJ746823Medicare ID - Type Unspecified