Provider Demographics
NPI:1659523264
Name:EMERGENCY MEDICAL CONSULTANTS OF SOUTH JERSEY LLC
Entity Type:Organization
Organization Name:EMERGENCY MEDICAL CONSULTANTS OF SOUTH JERSEY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ESMAT
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAROBEEM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-672-8400
Mailing Address - Street 1:PO BOX 24238
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07189-0001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:300 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07018-2819
Practice Address - Country:US
Practice Address - Phone:973-672-8400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-14
Last Update Date:2009-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
614202700OtherDEPT OF LABOR
NJ0186511Medicaid
DO7055OtherRAILROAD MEDICARE
NJ0186511Medicaid