Individual
SANDY IBRAHIM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LAC
Contact information
Practice address
100 METROPLEX DR, EDISON, NJ 08817-2684
(732) 235-8443
Mailing address
671 HOES LN W, PISCATAWAY, NJ 08854-8021
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
37AC00439800
NJ
Other
Enumeration date
12/27/2018
Last updated
12/27/2018
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