MEDICARE: ADVANCE MEDICINE OF WEST ESSEX PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	MA65186	NJ

General Provider Information

NPI Number	:	1083915821
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCE MEDICINE OF WEST ESSEX PA

Provider Business Mailing Address
First Line	:	15 OAK TER
Second Line	:
City	:	WEST ORANGE
State	:	NJ
Zip	:	07052-2117
Country	:	US
Telephone Number	:	973-736-0687
Fax Number	:

Provider Business Practice Location Address
First Line	:	15 OAK TER
Second Line	:
City	:	WEST ORANGE
State	:	NJ
Zip	:	07052-2117
Country	:	US
Telephone Number	:	973-736-0687
Fax Number	:

Authorized Official
Title or Position	:	MD
Name	:	SOMAYA ABBOUD
Credential	:
Telephone Number	:	973-736-0687

Provider Enumeration Date	:	11/10/2010
Last Update Date	:	11/10/2010

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