NPIMap

Individual provider Active NPI

Essam Abdou Othman, MD

  • Internal Medicine Physician
  • Elizabeth, NJ
National Provider Identifier
1891897229
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
25MA06234900 Issued in NJ
Practice address
700 N Broad St
Ste #LL4 Family Medical Group
Elizabeth, NJ 07208-2310
Phone
(908) 436-0022
Fax
(908) 436-0088
NPI assigned
Sep 5, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 25MA06234900 NJ Primary

Addresses

Primary practice location

700 N Broad St
Ste #LL4 Family Medical Group
Elizabeth, NJ 07208-2310

Mailing address

700 N Broad St
Ste #LL4 Family Medical Group
Elizabeth, NJ 07208-2310
Phone (908) 436-0022

Other identifiers 1

IdentifierTypeStateIssuer
7077009MedicaidNJ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050617000019 NJ Practitioner - Internal Medicine 2062456346 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1979
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

700 N Broad St
Suite LL4
Elizabeth, NJ 07208-2310
Phone (908) 436-0022

Hospital & facility affiliations

  • Serenity Hospice Care Hospice, Trenton, NJ, CCN 311574
  • Trinitas Regional Medical Center Hospital, Elizabeth, NJ, CCN 310027
  • Cornell Hall Care & Rehabilitation Center Nursing home, Union, NJ, CCN 315104
  • Elmora Hills Health & Rehabilitation Center Nursing home, Elizabeth, NJ, CCN 315010
  • Plaza Healthcare & Rehabilitation Center Nursing home, Elizabeth, NJ, CCN 315483
  • Elizabeth Nursing and Rehab Center Nursing home, Elizabeth, NJ, CCN 315106

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
25MA06234900NJMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Family Medical Group, PC CurrentSince Jan 4, 2010 Accepting new patients
Family Medical Group, P.C. Past Accepting new patients
Immediate Care P.C. Past Accepting new patients
Trinitas Regional Medical Center Past Accepting new patients

Locations

700 N Broad St
Elizabeth, NJ 07208
Phone (908) 354-1045

700 N Broad St
Ste LL4
Elizabeth, NJ 07208
Phone (908) 436-0022

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 9

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1157414400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1891897229",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 N BROAD ST",
            "address_2": "STE #LL4 FAMILY MEDICAL GROUP",
            "city": "ELIZABETH",
            "state": "NJ",
            "postal_code": "072082310",
            "telephone_number": "908-436-0022",
            "fax_number": "908-436-0088"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 N BROAD ST",
            "address_2": "STE #LL4 FAMILY MEDICAL GROUP",
            "city": "ELIZABETH",
            "state": "NJ",
            "postal_code": "072082310",
            "telephone_number": "908-436-0022",
            "fax_number": "908-436-0088"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OTHMAN",
        "first_name": "ESSAM",
        "middle_name": "ABDOU",
        "name_prefix": "Mr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-05",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NJ",
            "license": "25MA06234900",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7077009",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Elizabeth, NJ

Sources for this page

Verify at the official NPI Registry.