Provider Demographics
NPI:1487447355
Name:VANTAGE LIFE INSTITUTE NJ, P.A.
Entity type:Organization
Organization Name:VANTAGE LIFE INSTITUTE NJ, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:HISHAM
Authorized Official - Last Name:HAMAWY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:908-490-5037
Mailing Address - Street 1:106 STANHOPE ST
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-5756
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:106 STANHOPE ST
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-5756
Practice Address - Country:US
Practice Address - Phone:908-490-5037
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-23
Last Update Date:2025-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty