Provider Demographics
NPI:1992028633
Name:IBRAHIM, NEVEN (RPH)
Entity Type:Individual
Prefix:
First Name:NEVEN
Middle Name:
Last Name:IBRAHIM
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 W 96TH ST
Mailing Address - Street 2:APT # 7A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-6518
Mailing Address - Country:US
Mailing Address - Phone:917-675-7921
Mailing Address - Fax:
Practice Address - Street 1:414 6TH AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-8416
Practice Address - Country:US
Practice Address - Phone:212-533-2700
Practice Address - Fax:212-228-8140
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-09
Last Update Date:2010-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03084500183500000X
NY047970-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00265807Medicaid