Active NPI
Mariam Ghobriel, M.D.
- Interventional Pain Medicine Physician
- Freehold, NJ
National Provider Identifier
1225040397
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Interventional Pain Medicine Physician
- License
- 25MA07975600
- Practice address
- 800 W Main St
111
Freehold, NJ 07728-2554 - Phone
- (732) 303-0102
- Fax
- (732) 637-8539
- NPI assigned
- Aug 13, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pain Medicine (Anesthesiology) Physician | 207LP2900X | 25MA007975600 | NJ | |
| Interventional Pain Medicine Physician | 208VP0014X | 25MA07975600 | NJ | Primary |
Addresses
Primary practice location
800 W Main St
111
Freehold, NJ 07728-2554
Mailing address
800 W Main St
111
Freehold, NJ 07728-2554
Phone (732) 303-0102
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 25MA007975600 | NJ | MD | Pain Medicine (Anesthesiology) Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Liberty Pain Center, LLC | Interventional Pain Medicine | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155427200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1458086400000",
"number": "1225040397",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "800 W MAIN ST",
"address_2": "111",
"city": "FREEHOLD",
"state": "NJ",
"postal_code": "077282554",
"telephone_number": "732-303-0102",
"fax_number": "732-637-8539"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "800 W MAIN ST",
"address_2": "111",
"city": "FREEHOLD",
"state": "NJ",
"postal_code": "077282554",
"telephone_number": "732-303-0102",
"fax_number": "732-637-8539"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GHOBRIEL",
"first_name": "MARIAM",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-13",
"last_updated": "2016-03-16",
"status": "A"
},
"taxonomies": [
{
"code": "207LP2900X",
"taxonomy_group": "",
"desc": "Anesthesiology, Pain Medicine",
"state": "NJ",
"license": "25MA007975600",
"primary": false
},
{
"code": "208VP0014X",
"taxonomy_group": "",
"desc": "Pain Medicine, Interventional Pain Medicine",
"state": "NJ",
"license": "25MA07975600",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Freehold, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.