Basic Information
| Provider Information | |||||||||
| NPI: | 1477722502 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ESSEN MEDICAL ASSOCIATES,PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1434 WILLIAMSBRIDGE RD FL 2 | ||||||||
| Address2: | |||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104612507 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7186180401 | ||||||||
| FaxNumber: | 3474791303 | ||||||||
| Practice Location | |||||||||
| Address1: | 1181 GRAND CONCOURSE | ||||||||
| Address2: | |||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104528503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7186816565 | ||||||||
| FaxNumber: | 7186811201 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/22/2008 | ||||||||
| LastUpdateDate: | 10/19/2020 | ||||||||
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| AuthorizedOfficialLastName: | AGGARWAL | ||||||||
| AuthorizedOfficialFirstName: | MANSI | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 7187312020 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 10/19/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 209800000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Legal Medicine |
ID Information
| ID | Type | State | Issuer | Description | W34691 | 01 | MEDICARE ID | OTHER | 02880591 | 05 | NY | MEDICAID |