Healthcare Provider Details

I. General information

NPI: 1891897229
Provider Name (Legal Business Name): ESSAM ABDOU OTHMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 N BROAD ST STE #LL4 FAMILY MEDICAL GROUP
ELIZABETH NJ
07208-2310
US

IV. Provider business mailing address

700 N BROAD ST STE #LL4 FAMILY MEDICAL GROUP
ELIZABETH NJ
07208-2310
US

V. Phone/Fax

Practice location:
  • Phone: 908-436-0022
  • Fax: 908-436-0088
Mailing address:
  • Phone: 908-436-0022
  • Fax: 908-436-0088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA06234900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: