Healthcare Provider Details

I. General information

NPI: 1841128196
Provider Name (Legal Business Name): NUTRIAMED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2026
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 HINGSTON AVE STE 102
EGG HARBOR TOWNSHIP NJ
08234-4409
US

IV. Provider business mailing address

3100 HINGSTON AVE STE 102
EGG HARBOR TOWNSHIP NJ
08234-4409
US

V. Phone/Fax

Practice location:
  • Phone: 609-415-2888
  • Fax: 609-380-2424
Mailing address:
  • Phone: 609-415-2888
  • Fax: 609-380-2424

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. SAMAR BURSHEH
Title or Position: OWNER
Credential: MD
Phone: 201-240-5067