Provider Demographics
NPI:1639605041
Name:TERZIBACHI, MICHEL SAMIR (MD)
Entity Type:Individual
Prefix:
First Name:MICHEL
Middle Name:SAMIR
Last Name:TERZIBACHI
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 1:1 KALISA WAY
Mailing Address - Street 2:SUITE 210
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652
Mailing Address - Country:US
Mailing Address - Phone:201-447-0013
Mailing Address - Fax:201-255-4515
Practice Address - Street 1:1 KALISA WAY
Practice Address - Street 2:SUITE 210
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652
Practice Address - Country:US
Practice Address - Phone:201-447-0013
Practice Address - Fax:201-255-4515
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-04
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NJ25MA10824300208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Multi-Specialty