Provider Demographics
NPI:1538428677
Name:ABDELRAHMAN, BADRELDIN (MD)
Entity type:Individual
Prefix:
First Name:BADRELDIN
Middle Name:
Last Name:ABDELRAHMAN
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 1:840S WOOD ST 1262
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-4325
Mailing Address - Country:US
Mailing Address - Phone:312-996-4185
Mailing Address - Fax:
Practice Address - Street 1:355 GRAND ST
Practice Address - Street 2:NICU
Practice Address - City:JERSEY CITY MEDICAL CENTER
Practice Address - State:NJ
Practice Address - Zip Code:07302
Practice Address - Country:US
Practice Address - Phone:201-915-2330
Practice Address - Fax:201-915-2705
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-10
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA103633002080N0001X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ06442258Medicaid