1235448564 NPI number — ESA SOUTH JERSEY BARIATRICS, P.A.

Table of content: (NPI 1235448564)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235448564 NPI number — ESA SOUTH JERSEY BARIATRICS, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ESA SOUTH JERSEY BARIATRICS, P.A.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1235448564
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1103 WEST SHERMAN AVENUE
Provider Second Line Business Mailing Address:
BUILDING 2 UNIT C
Provider Business Mailing Address City Name:
VINELAND
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08360
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-362-5259
Provider Business Mailing Address Fax Number:
856-407-6978

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1103 WEST SHERMAN AVENUE
Provider Second Line Business Practice Location Address:
BUILDING 2 UNIT C
Provider Business Practice Location Address City Name:
VINELAND
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08360
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-362-5259
Provider Business Practice Location Address Fax Number:
856-405-6978
Provider Enumeration Date:
10/05/2010

Additional Information

Authorized Official

Authorized Official Last Name:
ATTIA
Authorized Official First Name:
AHMED
Authorized Official Middle Name:
FAROUK
Authorized Official Title or Position:
PHYSICIAN/PROPRIETOR
Authorized Official Telephone Number:
856-362-5259

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  25MB082666100 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2785305 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 60072276 . This is a "HORIZON NJ HEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 01004632800 . This is a "AMERICHOICE-UHC COMMUNITY PLAN" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 3811510001 . This is a "AMERIHEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: P3868269 . This is a "OXFORD-UNITED HEALTHCARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 5974712 . This is a "CIGNA HEALTHCARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0148911 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2871684000 . This is a "AMERIHEALTH HMO" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com