Healthcare Provider Details

I. General information

NPI: 1992632087
Provider Name (Legal Business Name): MID ATLANTIC HEALTHCARE SERVICES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2026
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 LYNN SHORES DR
VIRGINIA BEACH VA
23452-2416
US

IV. Provider business mailing address

175 ROUTE 70 STE 203
TOMS RIVER NJ
08755-0954
US

V. Phone/Fax

Practice location:
  • Phone: 212-734-6621
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: SIMON FENSTERSZAUB
Title or Position: DO
Credential:
Phone: 917-863-8499