Provider Demographics
NPI:1659711919
Name:BEBAWY, NIVEEN (MD)
Entity Type:Individual
Prefix:
First Name:NIVEEN
Middle Name:
Last Name:BEBAWY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 31ST ST BSMT
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07087-3907
Mailing Address - Country:US
Mailing Address - Phone:201-866-3322
Mailing Address - Fax:201-866-2289
Practice Address - Street 1:510 31ST ST BSMT
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:NJ
Practice Address - Zip Code:07087-3907
Practice Address - Country:US
Practice Address - Phone:201-866-3322
Practice Address - Fax:201-866-2289
Is Sole Proprietor?:No
Enumeration Date:2013-07-01
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09914000207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0572594Medicaid