MEDICARE: EILEEN AVERSA NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	26NJ00043200	NJ

General Provider Information

NPI Number	:	1275582157
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EILEEN AVERSA NP

Provider Business Mailing Address
First Line	:	3600 ROUTE 66 STE 400
Second Line	:
City	:	NEPTUNE
State	:	NJ
Zip	:	07753-2645
Country	:	US
Telephone Number	:	732-363-6655
Fax Number	:	732-363-6656

Provider Business Practice Location Address
First Line	:	2106 NEW RD STE D4
Second Line	:
City	:	LINWOOD
State	:	NJ
Zip	:	08221-1050
Country	:	US
Telephone Number	:	609-926-8899
Fax Number	:	609-926-6474

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/09/2006
Last Update Date	:	06/29/2023

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