Healthcare Provider Details

I. General information

NPI: 1225021405
Provider Name (Legal Business Name): LUKE EDMUND EYERMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/24/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 GRAND AVE
PALISADES PARK NJ
07650-1007
US

IV. Provider business mailing address

103 GRAND AVE
PALISADES PARK NJ
07650-1007
US

V. Phone/Fax

Practice location:
  • Phone: 201-947-7642
  • Fax: 201-944-9558
Mailing address:
  • Phone: 201-947-7642
  • Fax: 201-944-9558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25MA07823000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: