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General NPI Number Information
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NPI Number | 1679510143
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Entity Type | Individual
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Provider Name | ESSAM-ELDIN M ELLABBAD MD
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Gender | Male
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Dates
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Enumeration Date | 06/01/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3100 PRINCETON PIK BUILDG 4 SUITE C
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City | LAWRENCEVILLE
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State | NJ
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Zip | 08648
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Country | US
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Telephone | 609-844-0900
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Fax | 609-895-8830
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Provider Business Mailing Address
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Address Line | 14 DORSET COURT
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City | PRINCETON
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State | NJ
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Zip | 08540
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Country | US
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Telephone | 609-844-0900
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Fax | 609-895-8830
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 25MA076464
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License Number State | NJ
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