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General NPI Number Information
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NPI Number | 1275582157
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Entity Type | Individual
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Provider Name | EILEEN AVERSA NP
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Gender | Female
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Dates
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Enumeration Date | 05/09/2006
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Last Update Date | 06/29/2023
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Provider Practice Location Address
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Address Line | 2106 NEW RD STE D4
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City | LINWOOD
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State | NJ
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Zip | 08221-1050
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Country | US
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Telephone | 609-926-8899
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Fax | 609-926-6474
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Provider Business Mailing Address
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Address Line | 3600 ROUTE 66 STE 400
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City | NEPTUNE
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State | NJ
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Zip | 07753-2645
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Country | US
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Telephone | 732-363-6655
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Fax | 732-363-6656
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 26NJ00043200
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License Number State | NJ
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