Provider Demographics
NPI:1235448564
Name:ESA SOUTH JERSEY BARIATRICS, P.A.
Entity Type:Organization
Organization Name:ESA SOUTH JERSEY BARIATRICS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/PROPRIETOR
Authorized Official - Prefix:MR
Authorized Official - First Name:AHMED
Authorized Official - Middle Name:FAROUK
Authorized Official - Last Name:ATTIA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:856-362-5259
Mailing Address - Street 1:1103 WEST SHERMAN AVENUE
Mailing Address - Street 2:BUILDING 2 UNIT C
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08360
Mailing Address - Country:US
Mailing Address - Phone:856-362-5259
Mailing Address - Fax:856-407-6978
Practice Address - Street 1:1103 WEST SHERMAN AVENUE
Practice Address - Street 2:BUILDING 2 UNIT C
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360
Practice Address - Country:US
Practice Address - Phone:856-362-5259
Practice Address - Fax:856-405-6978
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-05
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB082666100208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2785305OtherUNITED HEALTHCARE
NJ60072276OtherHORIZON NJ HEALTH
NJ01004632800OtherAMERICHOICE-UHC COMMUNITY PLAN
NJ3811510001OtherAMERIHEALTH
NJP3868269OtherOXFORD-UNITED HEALTHCARE
NJ5974712OtherCIGNA HEALTHCARE
NJ0148911Medicaid
NJ2871684000OtherAMERIHEALTH HMO
NJ3811510001OtherAMERIHEALTH