Provider Demographics
NPI:1669748695
Name:IBRAHIM, MARIANE (MD)
Entity type:Individual
Prefix:
First Name:MARIANE
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 1:1314 HOOPER AVE BLDG A2ND
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-2586
Mailing Address - Country:US
Mailing Address - Phone:322-557-5537
Mailing Address - Fax:732-255-8901
Practice Address - Street 1:1314 HOOPER AVE BLDG A2ND
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-2586
Practice Address - Country:US
Practice Address - Phone:322-557-5537
Practice Address - Fax:732-255-8901
Is Sole Proprietor?:No
Enumeration Date:2012-03-23
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09632000208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics