| Enidammy Family Practice Llc | |
|
2177 Oak Tree Rd Ste 206 Edison NJ 08820-1082 | |
| (908) 755-4000 | |
| (908) 755-4006 |
| Full Name | Enidammy Family Practice Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 2177 Oak Tree Rd Ste 206, Edison, New Jersey |
| Authorized Official Name and Position | Kehinde Ibitola (PROPRIETOR) |
| Authorized Official Contact | 9734930026 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Enidammy Family Practice Llc 2177 Oak Tree Rd Ste 206 Edison NJ 08820-1082 Ph: (908) 755-4000 | Enidammy Family Practice Llc 2177 Oak Tree Rd Ste 206 Edison NJ 08820-1082 Ph: (908) 755-4000 |
| NPI Number | 1548906837 |
|---|---|
| Provider Enumeration Date | 05/09/2022 |
| Last Update Date | 05/09/2022 |
| Medicare PECOS PAC ID | 1951783323 |
|---|---|
| Medicare Enrollment ID | O20220802000053 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548906837 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Joseph G Anton |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1396831814 PECOS PAC ID: 5698722528 Enrollment ID: I20050404000387 |
| Provider Name | Suruchi B Desai |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1932456951 PECOS PAC ID: 4183845100 Enrollment ID: I20141016000758 |
| Provider Name | Kehinde Ibitola |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194293530 PECOS PAC ID: 0840538351 Enrollment ID: I20190207002175 |
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