Provider Demographics
NPI:1144292210
Name:IBANEZ, DELFIN GEORGE C (MD)
Entity type:Individual
Prefix:
First Name:DELFIN
Middle Name:GEORGE C
Last Name:IBANEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 COURT ST
Mailing Address - Street 2:
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-1709
Mailing Address - Country:US
Mailing Address - Phone:732-780-7387
Mailing Address - Fax:732-780-5257
Practice Address - Street 1:37 COURT ST
Practice Address - Street 2:
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-1709
Practice Address - Country:US
Practice Address - Phone:732-780-7387
Practice Address - Fax:732-780-5257
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA0696622084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJA98661Medicare UPIN