Healthcare Provider Details

I. General information

NPI: 1275582157
Provider Name (Legal Business Name): EILEEN AVERSA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EILEEN AVERSA DNP

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 06/29/2023
Certification Date: 06/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2106 NEW RD STE D4
LINWOOD NJ
08221-1050
US

IV. Provider business mailing address

3600 ROUTE 66 STE 400
NEPTUNE NJ
07753-2645
US

V. Phone/Fax

Practice location:
  • Phone: 609-926-8899
  • Fax: 609-926-6474
Mailing address:
  • Phone: 732-363-6655
  • Fax: 732-363-6656

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ00043200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: