Provider Demographics
NPI:1013006915
Name:MARSAN, ENA ALYESE (DO)
Entity Type:Individual
Prefix:DR
First Name:ENA
Middle Name:ALYESE
Last Name:MARSAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:466 OLD HOOK RD STE 1
Mailing Address - Street 2:
Mailing Address - City:EMERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07630-1368
Mailing Address - Country:US
Mailing Address - Phone:201-967-8221
Mailing Address - Fax:
Practice Address - Street 1:1 W RIDGEWOOD AVE STE 211
Practice Address - Street 2:
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-2361
Practice Address - Country:US
Practice Address - Phone:201-251-2323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY242519207V00000X
NJ25MB07969500207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2624630OtherUNITED HEALTH CARE
NJ41114OtherUHP
NJ60017939OtherHORIXON NJ HEALTH
NJ91001907701OtherAMERICHOICE
NJ25MB07969500BNEOtherHEALTH FIRST
NJ222290124AOtherHORIZON BLUE CROSS/BLUE SHIELD
NJ0103268Medicaid
NJ9652165OtherAETNA
NJ01130438OtherAMERIGROUP