Provider Demographics
NPI:1811103153
Name:DIALA JABER, MD, PC
Entity type:Organization
Organization Name:DIALA JABER, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:DIALA
Authorized Official - Middle Name:
Authorized Official - Last Name:JABER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-673-6669
Mailing Address - Street 1:232 E MAIN ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-2920
Mailing Address - Country:US
Mailing Address - Phone:631-673-6669
Mailing Address - Fax:631-673-6071
Practice Address - Street 1:232 E MAIN ST
Practice Address - Street 2:SUITE 2
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-2920
Practice Address - Country:US
Practice Address - Phone:631-673-6669
Practice Address - Fax:631-673-6071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY196793207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty