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General NPI Number Information
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NPI Number | 1235448564
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Entity Type | Organization
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Legal Business Name | ESA SOUTH JERSEY BARIATRICS, P.A.
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Dates
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Enumeration Date | 10/05/2010
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Last Update Date | 03/07/2022
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Provider Practice Location Address
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Address Line | 1103 WEST SHERMAN AVENUE BUILDING 2 UNIT C
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City | VINELAND
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State | NJ
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Zip | 08360
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Country | US
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Telephone | 856-362-5259
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Fax | 856-405-6978
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Provider Business Mailing Address
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Address Line | 1103 WEST SHERMAN AVENUE BUILDING 2 UNIT C
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City | VINELAND
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State | NJ
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Zip | 08360
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Country | US
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Telephone | 856-362-5259
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Fax | 856-407-6978
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Authorized Official
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Title or Position | PHYSICIAN/PROPRIETOR
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Name | MR. AHMED FAROUK ATTIA
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Credential | D.O.
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Telephone | 856-362-5259
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 25MB082666100
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License Number State | NJ
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