Provider Demographics
NPI:1598591711
Name:JABER, MOAYAD
Entity type:Individual
Prefix:
First Name:MOAYAD
Middle Name:
Last Name:JABER
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 1:11000 CENTRAL AVE APT 3B
Mailing Address - Street 2:
Mailing Address - City:CHICAGO RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60415-2435
Mailing Address - Country:US
Mailing Address - Phone:708-890-8717
Mailing Address - Fax:
Practice Address - Street 1:8837 RIDGELAND AVE
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-1002
Practice Address - Country:US
Practice Address - Phone:708-890-8717
Practice Address - Fax:708-529-7064
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-12
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL3002689251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health