Provider Demographics
NPI:1255003810
Name:EBLA'S OCCUPATIONAL, LLC
Entity Type:Organization
Organization Name:EBLA'S OCCUPATIONAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MHD HICHAM
Authorized Official - Middle Name:
Authorized Official - Last Name:ALNACHAWATI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-699-2025
Mailing Address - Street 1:600 SOMERDALE RD STE 212
Mailing Address - Street 2:
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-1858
Mailing Address - Country:US
Mailing Address - Phone:856-432-3232
Mailing Address - Fax:856-432-3233
Practice Address - Street 1:600 SOMERDALE RD STE 212
Practice Address - Street 2:
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-1858
Practice Address - Country:US
Practice Address - Phone:856-432-3232
Practice Address - Fax:856-432-3233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-01
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational MedicineGroup - Multi-Specialty
No209800000XAllopathic & Osteopathic PhysiciansLegal MedicineGroup - Multi-Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine