Healthcare Provider Details

I. General information

NPI: 1235448564
Provider Name (Legal Business Name): ESA SOUTH JERSEY BARIATRICS, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2010
Last Update Date: 03/07/2022
Certification Date: 03/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1103 WEST SHERMAN AVENUE BUILDING 2 UNIT C
VINELAND NJ
08360
US

IV. Provider business mailing address

1103 WEST SHERMAN AVENUE BUILDING 2 UNIT C
VINELAND NJ
08360
US

V. Phone/Fax

Practice location:
  • Phone: 856-362-5259
  • Fax: 856-405-6978
Mailing address:
  • Phone: 856-362-5259
  • Fax: 856-407-6978

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number25MB082666100
License Number StateNJ

VIII. Authorized Official

Name: MR. AHMED FAROUK ATTIA
Title or Position: PHYSICIAN/PROPRIETOR
Credential: D.O.
Phone: 856-362-5259