MEDICARE: DR. LUKE EDMUND EYERMAN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	25MA07823000	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3778092	OTHER	NJ	AETNA
2	P3578244	OTHER	NJ	OXFORD

General Provider Information

NPI Number	:	1225021405
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LUKE EDMUND EYERMAN M.D.

Provider Business Mailing Address
First Line	:	103 GRAND AVE
Second Line	:
City	:	PALISADES PARK
State	:	NJ
Zip	:	07650-1007
Country	:	US
Telephone Number	:	201-947-7642
Fax Number	:	201-944-9558

Provider Business Practice Location Address
First Line	:	103 GRAND AVE
Second Line	:
City	:	PALISADES PARK
State	:	NJ
Zip	:	07650-1007
Country	:	US
Telephone Number	:	201-947-7642
Fax Number	:	201-944-9558

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/24/2005
Last Update Date	:	07/08/2007

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