Provider Demographics
NPI:1770966806
Name:TARIK JBARAH
Entity type:Organization
Organization Name:TARIK JBARAH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TARIK
Authorized Official - Middle Name:W
Authorized Official - Last Name:JBARAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-632-8571
Mailing Address - Street 1:138 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:PA
Mailing Address - Zip Code:17331-2500
Mailing Address - Country:US
Mailing Address - Phone:717-632-8571
Mailing Address - Fax:717-632-6466
Practice Address - Street 1:138 BROADWAY
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:PA
Practice Address - Zip Code:17331-2500
Practice Address - Country:US
Practice Address - Phone:717-632-8571
Practice Address - Fax:717-632-6466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-07
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS036611261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental