Healthcare Provider Details

I. General information

NPI: 1053537019
Provider Name (Legal Business Name): ESSEX HEALTH CENTER PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 04/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 MOUNTAIN RIDGE DR
LIVINGSTON NJ
07039-3408
US

IV. Provider business mailing address

11 MOUNTAIN RIDGE DR
LIVINGSTON NJ
07039-3408
US

V. Phone/Fax

Practice location:
  • Phone: 973-266-2905
  • Fax:
Mailing address:
  • Phone: 973-266-2905
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0015X
TaxonomyPsychosomatic Medicine Physician
License Number25MA03373200
License Number StateNJ

VIII. Authorized Official

Name: DR. DHARAMSI D SHAH
Title or Position: PRESIDENT
Credential:
Phone: 973-266-2905