Provider Demographics
NPI:1053496398
Name:DEUTCHMAN, ERIC M (DPM)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:M
Last Name:DEUTCHMAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:706 WEST SAINT GEORGE AVENUE
Mailing Address - Street 2:
Mailing Address - City:LINDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07036
Mailing Address - Country:US
Mailing Address - Phone:908-486-3338
Mailing Address - Fax:
Practice Address - Street 1:706 WEST SAINT GEORGE AVENUE
Practice Address - Street 2:
Practice Address - City:LINDEN
Practice Address - State:NJ
Practice Address - Zip Code:07036
Practice Address - Country:US
Practice Address - Phone:908-486-3338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD001314NJ213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ461682Medicare PIN
NJT77760Medicare UPIN