Provider Demographics
NPI:1194165704
Name:IBRAIMI, NEDZMI
Entity type:Individual
Prefix:
First Name:NEDZMI
Middle Name:
Last Name:IBRAIMI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 WATERWAY RD
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-6325
Mailing Address - Country:US
Mailing Address - Phone:973-896-6433
Mailing Address - Fax:973-907-2335
Practice Address - Street 1:4 WATERWAY RD
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-6325
Practice Address - Country:US
Practice Address - Phone:973-896-6433
Practice Address - Fax:973-907-2335
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-27
Last Update Date:2013-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJR16120283416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ134115Medicare PIN