Provider Demographics
NPI:1982749479
Name:JABER, DIALA A (MD)
Entity Type:Individual
Prefix:
First Name:DIALA
Middle Name:A
Last Name:JABER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Last Name:
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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
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY196793207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYCP671OtherOXFORD HEALTH PLANS
NY196793OtherLICENSE NUMBER
NY860331OtherEMPIRE BLUE CROSS BLUE SH
NYG09080Medicare UPIN
NY196793OtherLICENSE NUMBER