Provider Demographics
NPI:1932163342
Name:IBRAHIM, JENNIFER (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:
Last Name:IBRAHIM
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 1:34 E BROAD ST
Mailing Address - Street 2:
Mailing Address - City:BERGENFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07621-3004
Mailing Address - Country:US
Mailing Address - Phone:201-387-1033
Mailing Address - Fax:201-503-1029
Practice Address - Street 1:350 ENGLE ST
Practice Address - Street 2:2 E
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-1808
Practice Address - Country:US
Practice Address - Phone:201-227-5526
Practice Address - Fax:201-503-1029
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA71003207SG0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8628853OtherCIGNA-SJMC
NH3609213OtherAETNA-SJMC
NJ2K5382OtherHEALTHNET-SJMC
NJ8333301Medicaid
NJP3168033OtherOXFORD-SJMC
NJ8333301Medicaid
NJ8628853OtherCIGNA-SJMC