=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386722718
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EISEN & ZIRKIN PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/02/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 50 US HIGHWAY 9 N SUITE 102
-----------------------------------------------------
City | MORGANVILLE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07751-1574
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-972-5922
-----------------------------------------------------
Fax | 732-972-6520
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 50 US HIGHWAY 9 N SUITE 102
-----------------------------------------------------
City | MORGANVILLE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07751-1574
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-972-5922
-----------------------------------------------------
Fax | 732-972-6520
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. SCOTT LOUIS ZIRKIN
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 732-972-5922
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223P0300X
-----------------------------------------------------
Taxonomy Name | Periodontics
-----------------------------------------------------
License Number | DI13109
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1223P0300X
-----------------------------------------------------
Taxonomy Name | Periodontics
-----------------------------------------------------
License Number | DI18372
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------