Provider Demographics
NPI:1538405147
Name:IBRAHIM, GEHAN (MD)
Entity type:Individual
Prefix:
First Name:GEHAN
Middle Name:
Last Name:IBRAHIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 STANLEY AVE
Mailing Address - Street 2:
Mailing Address - City:HASBROUCK HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:07604-2210
Mailing Address - Country:US
Mailing Address - Phone:201-321-2313
Mailing Address - Fax:
Practice Address - Street 1:87 BRUNSWICK WOODS DR
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-5601
Practice Address - Country:US
Practice Address - Phone:201-222-2682
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-31
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09456200207V00000X
282NW0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No282NW0100XHospitalsGeneral Acute Care HospitalWomenGroup - Multi-Specialty