Organization
FAMILY MEDICAL GROUP, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ESSAM ABDOU OTHMAN M.D. (OWNER)
(908) 436-0022
Entity
Organization
Contact information
Practice address
700 N BROAD ST, ELIZABETH, NJ 07208-2310
(908) 436-0022
Mailing address
700 N BROAD ST, ELIZABETH, NJ 07208-2310
(908) 436-0022
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
25MA06234900
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7077009
—
NJ
Enumeration date
06/07/2010
Last updated
06/07/2010
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