Provider Demographics
NPI:1659007698
Name:ESSIBOR, FRED
Entity Type:Individual
Prefix:
First Name:FRED
Middle Name:
Last Name:ESSIBOR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:629 PURCE ST
Mailing Address - Street 2:
Mailing Address - City:HILLSIDE
Mailing Address - State:NJ
Mailing Address - Zip Code:07205-1716
Mailing Address - Country:US
Mailing Address - Phone:917-304-3268
Mailing Address - Fax:
Practice Address - Street 1:629 PURCE ST
Practice Address - Street 2:
Practice Address - City:HILLSIDE
Practice Address - State:NJ
Practice Address - Zip Code:07205-1716
Practice Address - Country:US
Practice Address - Phone:917-304-3268
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-30
Last Update Date:2022-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health