Healthcare Provider Details

I. General information

NPI: 1073628327
Provider Name (Legal Business Name): ESI MEDICAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 08/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2517 HIGHWAY 35 SUITE J201
MANASQUAN NJ
08736
US

IV. Provider business mailing address

2517 HIGHWAY 35 SUITE J201
MANASQUAN NJ
08736
US

V. Phone/Fax

Practice location:
  • Phone: 732-292-0101
  • Fax: 732-292-9911
Mailing address:
  • Phone: 732-292-0101
  • Fax: 732-292-9911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberHP0070900
License Number StateNJ

VIII. Authorized Official

Name: PHILIP G PASSES
Title or Position: MANAGING PARTNER
Credential: DO
Phone: 732-292-0101