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NPI Code Detail

MEDICARE: DR. DEBORAH IDA EISEN MD

MEDICARE: DR. DEBORAH IDA EISEN MD
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
1207RP1001XPulmonary Disease Physician25MA06408000NJ

General Provider Information

NPI Number : 1265428874
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DEBORAH IDA EISEN MD
Provider Business Mailing Address
First Line : 530 LAKEHURST RD
Second Line : SUITE 306
City : TOMS RIVER
State : NJ
Zip : 08755-8063
Country : US
Telephone Number : 732-818-9400
Fax Number : 732-818-0210
Provider Business Practice Location Address
First Line : 530 LAKEHURST RD
Second Line : SUITE 306
City : TOMS RIVER
State : NJ
Zip : 08755-8063
Country : US
Telephone Number : 732-818-9400
Fax Number : 732-818-0210
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/20/2005
Last Update Date : 02/13/2008

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