Provider Demographics
NPI:1073628327
Name:ESI MEDICAL, LLC
Entity type:Organization
Organization Name:ESI MEDICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:G
Authorized Official - Last Name:PASSES
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:732-292-0101
Mailing Address - Street 1:2517 HIGHWAY 35
Mailing Address - Street 2:SUITE J201
Mailing Address - City:MANASQUAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08736
Mailing Address - Country:US
Mailing Address - Phone:732-292-0101
Mailing Address - Fax:732-292-9911
Practice Address - Street 1:2517 HIGHWAY 35
Practice Address - Street 2:SUITE J201
Practice Address - City:MANASQUAN
Practice Address - State:NJ
Practice Address - Zip Code:08736
Practice Address - Country:US
Practice Address - Phone:732-292-0101
Practice Address - Fax:732-292-9911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2008-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJHP0070900251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health