Provider Demographics
NPI:1144237835
Name:LONDON, ERIC BART (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:BART
Last Name:LONDON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 913
Mailing Address - Street 2:
Mailing Address - City:SMALLWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:12778
Mailing Address - Country:US
Mailing Address - Phone:609-921-0332
Mailing Address - Fax:718-494-3650
Practice Address - Street 1:328 WOODSTONE TRAIL
Practice Address - Street 2:
Practice Address - City:WHITE LAKE
Practice Address - State:NY
Practice Address - Zip Code:12786
Practice Address - Country:US
Practice Address - Phone:609-921-0332
Practice Address - Fax:718-494-3650
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2015-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ474302084P0800X
NY141255-12084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ441219B1LOtherMEDICARE BILLING NO.
NJ441219B1LOtherMEDICARE BILLING NO.
NJB79203Medicare UPIN