Provider Demographics
NPI:1245291285
Name:SHEIBAN, TUTI FAREEN (MD)
Entity type:Individual
Prefix:
First Name:TUTI
Middle Name:FAREEN
Last Name:SHEIBAN
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 1:625 FRANKLIN TPKE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-1913
Mailing Address - Country:US
Mailing Address - Phone:201-447-3100
Mailing Address - Fax:201-447-3400
Practice Address - Street 1:625 FRANKLIN TPKE
Practice Address - Street 2:SUITE 3
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-1913
Practice Address - Country:US
Practice Address - Phone:201-447-3100
Practice Address - Fax:201-447-3400
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-29
Last Update Date:2010-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA025670207VG0400X
NJ25MA08502500207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA4K099Medicare ID - Type Unspecified
I51506Medicare UPIN