Provider Demographics
NPI:1326366386
Name:MBAIDJOL, MOROMBAYE KABRA (MD)
Entity type:Individual
Prefix:DR
First Name:MOROMBAYE
Middle Name:KABRA
Last Name:MBAIDJOL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 GORGE RD APT 62G
Mailing Address - Street 2:
Mailing Address - City:CLIFFSIDE PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07010-2773
Mailing Address - Country:US
Mailing Address - Phone:201-349-5167
Mailing Address - Fax:
Practice Address - Street 1:300 GORGE RD APT 62G
Practice Address - Street 2:
Practice Address - City:CLIFFSIDE PARK
Practice Address - State:NJ
Practice Address - Zip Code:07010-2773
Practice Address - Country:US
Practice Address - Phone:201-349-5167
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-14
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY271767207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine