Provider Demographics
NPI:1851378244
Name:ESSEX EMERGENCY PHYSICIANS, PC
Entity Type:Organization
Organization Name:ESSEX EMERGENCY PHYSICIANS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:S
Authorized Official - Last Name:ROSENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:866-272-3030
Mailing Address - Street 1:2828 CROASDAILE DR
Mailing Address - Street 2:ESSEX EMERGENCY PHYSICIANS
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-2505
Mailing Address - Country:US
Mailing Address - Phone:866-272-3030
Mailing Address - Fax:919-425-0474
Practice Address - Street 1:300 CENTRAL AVE
Practice Address - Street 2:ESSEX EMERGENCY PHYSICIANS
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:2005-12-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB06960500207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0076422Medicaid
NJ0076422Medicaid