Provider Demographics
NPI:1962524975
Name:TABBARAH, KHALID ZUHAYR (MD)
Entity type:Individual
Prefix:DR
First Name:KHALID
Middle Name:ZUHAYR
Last Name:TABBARAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:201 LYONS AVE # F4
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07112-2027
Mailing Address - Country:US
Mailing Address - Phone:386-748-3994
Mailing Address - Fax:
Practice Address - Street 1:201 LYONS AVE # F4
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07112-2027
Practice Address - Country:US
Practice Address - Phone:973-926-7331
Practice Address - Fax:973-926-2997
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA095910002084N0400X, 2084N0600X, 2084S0012X
NC2005-015882084N0400X, 2084N0600X
FLME 1089152084N0400X
PAMD4308792084N0600X, 2084N0400X
NC2005015882084S0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
No2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ25MA09591000Medicare PIN