Provider Demographics
NPI:1447251764
Name:ZAGHLOUL, NIBAL AHMAD (MD)
Entity type:Individual
Prefix:DR
First Name:NIBAL
Middle Name:AHMAD
Last Name:ZAGHLOUL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:254 EASTON AVE
Mailing Address - Street 2:
Mailing Address - City:NEW BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08901-1766
Mailing Address - Country:US
Mailing Address - Phone:732-745-6674
Mailing Address - Fax:732-418-9708
Practice Address - Street 1:254 EASTON AVE
Practice Address - Street 2:
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901-1766
Practice Address - Country:US
Practice Address - Phone:732-745-6674
Practice Address - Fax:732-418-9708
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2012-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350863912080P0207X
NJ25MA088401002080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0259144Medicaid
NJMA08840100OtherSTATE LICENSE
NJMA08840100OtherSTATE LICENSE