Provider Demographics
NPI:1073942843
Name:EISENBRAUN, JILLIAN (PA C)
Entity Type:Individual
Prefix:
First Name:JILLIAN
Middle Name:
Last Name:EISENBRAUN
Suffix:
Gender:F
Credentials:PA C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 WOODBINE AVE
Mailing Address - Street 2:
Mailing Address - City:LITTLE SILVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07739-1313
Mailing Address - Country:US
Mailing Address - Phone:732-747-1420
Mailing Address - Fax:
Practice Address - Street 1:670 N BEERS ST
Practice Address - Street 2:BLDG 4 UNIT 2
Practice Address - City:HOLMDEL
Practice Address - State:NJ
Practice Address - Zip Code:07733-1516
Practice Address - Country:US
Practice Address - Phone:732-335-3434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-02
Last Update Date:2013-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00295400363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical