Provider Demographics
NPI:1740263219
Name:IBRANYI, GUSTAV LOUIS JR (DPM)
Entity type:Individual
Prefix:DR
First Name:GUSTAV
Middle Name:LOUIS
Last Name:IBRANYI
Suffix:JR
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:390 UNION AVE
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07109-2164
Mailing Address - Country:US
Mailing Address - Phone:973-759-4790
Mailing Address - Fax:973-759-4791
Practice Address - Street 1:390 UNION AVE
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07109-2164
Practice Address - Country:US
Practice Address - Phone:973-759-4790
Practice Address - Fax:973-759-4791
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-29
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00130400213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1482106Medicaid
T44886Medicare UPIN
NJ1482106Medicaid