Basic Information
| Provider Information | |||||||||
| NPI: | 1770966806 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | TARIK JBARAH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 138 BROADWAY | ||||||||
| Address2: | |||||||||
| City: | HANOVER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 173312500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7176328571 | ||||||||
| FaxNumber: | 7176326466 | ||||||||
| Practice Location | |||||||||
| Address1: | 138 BROADWAY | ||||||||
| Address2: | |||||||||
| City: | HANOVER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 173312500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7176328571 | ||||||||
| FaxNumber: | 7176326466 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2015 | ||||||||
| LastUpdateDate: | 07/07/2015 | ||||||||
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| AuthorizedOfficialLastName: | JBARAH | ||||||||
| AuthorizedOfficialFirstName: | TARIK | ||||||||
| AuthorizedOfficialMiddleName: | W | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7176328571 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QD0000X | DS036611 | PA | Y | Ambulatory Health Care Facilities | Clinic/Center | Dental |
No ID Information.