| Advance Medicine Of West Essex Pa | |
|
15 Oak Ter West Orange NJ 07052-2117 | |
| (973) 736-0687 | |
| Not Available |
| Full Name | Advance Medicine Of West Essex Pa |
|---|---|
| Speciality | Internal Medicine |
| Location | 15 Oak Ter, West Orange, New Jersey |
| Authorized Official Name and Position | Somaya Abboud (MD) |
| Authorized Official Contact | 9737360687 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Advance Medicine Of West Essex Pa 15 Oak Ter West Orange NJ 07052-2117 Ph: (973) 736-0687 | Advance Medicine Of West Essex Pa 15 Oak Ter West Orange NJ 07052-2117 Ph: (973) 736-0687 |
| NPI Number | 1083915821 |
|---|---|
| Provider Enumeration Date | 11/10/2010 |
| Last Update Date | 11/10/2010 |
| Medicare PECOS PAC ID | 8123208311 |
|---|---|
| Medicare Enrollment ID | O20110204000482 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083915821 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | MA65186 (New Jersey) | Primary |
| Provider Name | Somaya M Abboud |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1326089004 PECOS PAC ID: 5294714317 Enrollment ID: I20040714000291 |
| Provider Name | Revathi Kotla |
|---|---|
| Provider Type | Practitioner - Nephrology |
| Provider Identifiers | NPI Number: 1063506434 PECOS PAC ID: 9133154776 Enrollment ID: I20051003000102 |
| Provider Name | Esira J C Beaubrun |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1013276062 PECOS PAC ID: 3375843154 Enrollment ID: I20151201000197 |
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