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General NPI Number Information
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NPI Number | 1629082904
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Entity Type | Organization
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Legal Business Name | ESSAM ELLABBAD MD PA
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Dates
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Enumeration Date | 07/29/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 14 DORSET CT
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City | PRINCETON
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State | NJ
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Zip | 08540-7053
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Country | US
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Telephone | 609-419-1027
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Fax | 609-895-8830
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Provider Business Mailing Address
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Address Line | 3100 PRINCETON PIKE BUIDLING 4, SUITE C
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City | LAWRENCEVILLE
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State | NJ
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Zip | 08648-2300
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Country | US
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Telephone | 609-884-0900
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Fax | 609-895-8830
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Authorized Official
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Title or Position | PRESIDENT
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Name | ESSAM-ELDIN M. ELLABBAD
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Credential | M.D.
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Telephone | 609-844-0900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 1218244
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License Number State | NJ
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