Basic Information
| Provider Information | |||||||||
| NPI: | 1659523264 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EMERGENCY MEDICAL CONSULTANTS OF SOUTH JERSEY LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 24238 | ||||||||
| Address2: | |||||||||
| City: | NEWARK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 071890001 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 300 CENTRAL AVE | ||||||||
| Address2: | |||||||||
| City: | EAST ORANGE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070182819 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9736728400 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/14/2008 | ||||||||
| LastUpdateDate: | 10/19/2009 | ||||||||
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| AuthorizedOfficialLastName: | SHAROBEEM | ||||||||
| AuthorizedOfficialFirstName: | ESMAT | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER/PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9736728400 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 614202700 | 01 | DEPT OF LABOR | OTHER | 0186511 | 05 | NJ | MEDICAID | DO7055 | 01 | RAILROAD MEDICARE | OTHER |