Provider Demographics
NPI:1841879970
Name:IDABOLE, JANBECK (DO)
Entity type:Individual
Prefix:
First Name:JANBECK
Middle Name:
Last Name:IDABOLE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:JANBECK
Other - Middle Name:
Other - Last Name:AIDABOLOV
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:105 ROCK LEDGE TER
Mailing Address - Street 2:
Mailing Address - City:HALEDON
Mailing Address - State:NJ
Mailing Address - Zip Code:07508-1000
Mailing Address - Country:US
Mailing Address - Phone:973-832-6898
Mailing Address - Fax:
Practice Address - Street 1:176 PALISADE AVE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-1121
Practice Address - Country:US
Practice Address - Phone:201-795-8200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-06
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program