Healthcare Provider Details

I. General information

NPI: 1093543258
Provider Name (Legal Business Name): ERIC DWORSKY NP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2024
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

414 GRAND ST STE 14
JERSEY CITY NJ
07302-4240
US

IV. Provider business mailing address

54 MEYER RD
EDISON NJ
08817-4643
US

V. Phone/Fax

Practice location:
  • Phone: 201-616-0470
  • Fax: 201-479-8979
Mailing address:
  • Phone: 504-671-0263
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number26NJ15105200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: