Healthcare Provider Details

I. General information

NPI: 1184457558
Provider Name (Legal Business Name): ESRA ALRUSAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2024
Last Update Date: 08/21/2024
Certification Date: 08/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1104 RINGWOOD AVE
HASKELL NJ
07420-1515
US

IV. Provider business mailing address

10 JACKSONVILLE RD
TOWACO NJ
07082-1107
US

V. Phone/Fax

Practice location:
  • Phone: 973-831-3111
  • Fax:
Mailing address:
  • Phone: 732-540-8240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI04375500
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: