Provider Demographics
NPI:1134009384
Name:NORTH BROADWAY MEDICAL FAMILY PRACTICE PC
Entity type:Organization
Organization Name:NORTH BROADWAY MEDICAL FAMILY PRACTICE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NOOR
Authorized Official - Middle Name:
Authorized Official - Last Name:IBRAHEEM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-359-8750
Mailing Address - Street 1:469 N BROADWAY
Mailing Address - Street 2:DR. NOOR IBRAHEEM
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701-1960
Mailing Address - Country:US
Mailing Address - Phone:914-359-8750
Mailing Address - Fax:
Practice Address - Street 1:469 N BROADWAY
Practice Address - Street 2:DR. NOOR IBRAHEEM
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-1960
Practice Address - Country:US
Practice Address - Phone:914-359-8750
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-06
Last Update Date:2025-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY338031OtherLICENSE