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General NPI Number Information
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NPI Number | 1992632087
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Entity Type | Organization
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Legal Business Name | MID ATLANTIC HEALTHCARE SERVICES PC
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Dates
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Enumeration Date | 05/05/2026
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Last Update Date | 05/05/2026
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Provider Practice Location Address
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Address Line | 340 LYNN SHORES DR
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City | VIRGINIA BEACH
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State | VA
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Zip | 23452-2416
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Country | US
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Telephone | 212-734-6621
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Fax |
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Provider Business Mailing Address
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Address Line | 175 ROUTE 70 STE 203
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City | TOMS RIVER
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State | NJ
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Zip | 08755-0954
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DO
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Name | SIMON FENSTERSZAUB
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Credential |
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Telephone | 917-863-8499
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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