Provider Demographics
NPI:1588066625
Name:IRONBOUND OBGYN. LLC
Entity type:Organization
Organization Name:IRONBOUND OBGYN. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FARES
Authorized Official - Middle Name:
Authorized Official - Last Name:DIARBAKERLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-221-3122
Mailing Address - Street 1:716 BROAD ST
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07013-1645
Mailing Address - Country:US
Mailing Address - Phone:973-221-3122
Mailing Address - Fax:973-710-0620
Practice Address - Street 1:91 CONGRESS ST
Practice Address - Street 2:SUITE 2
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07105-1879
Practice Address - Country:US
Practice Address - Phone:973-344-7676
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-19
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty