Provider Demographics
NPI:1629082904
Name:ESSAM ELLABBAD MD PA
Entity Type:Organization
Organization Name:ESSAM ELLABBAD MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ESSAM-ELDIN
Authorized Official - Middle Name:M
Authorized Official - Last Name:ELLABBAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-844-0900
Mailing Address - Street 1:3100 PRINCETON PIKE
Mailing Address - Street 2:BUIDLING 4, SUITE C
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08648-2300
Mailing Address - Country:US
Mailing Address - Phone:609-884-0900
Mailing Address - Fax:609-895-8830
Practice Address - Street 1:14 DORSET CT
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-7053
Practice Address - Country:US
Practice Address - Phone:609-419-1027
Practice Address - Fax:609-895-8830
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1218244261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health