Provider Demographics
NPI:1891897229
Name:OTHMAN, ESSAM ABDOU (MD)
Entity Type:Individual
Prefix:MR
First Name:ESSAM
Middle Name:ABDOU
Last Name:OTHMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:700 N BROAD ST
Mailing Address - Street 2:STE #LL4 FAMILY MEDICAL GROUP
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07208-2310
Mailing Address - Country:US
Mailing Address - Phone:908-436-0022
Mailing Address - Fax:908-436-0088
Practice Address - Street 1:700 N BROAD ST
Practice Address - Street 2:STE #LL4 FAMILY MEDICAL GROUP
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07208-2310
Practice Address - Country:US
Practice Address - Phone:908-436-0022
Practice Address - Fax:908-436-0088
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA06234900207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7077009Medicaid
NJ7077009Medicaid
G35189Medicare UPIN