Provider Demographics
NPI:1164588711
Name:EGAN, SEAN CHRISTOPHER (MD)
Entity Type:Individual
Prefix:DR
First Name:SEAN
Middle Name:CHRISTOPHER
Last Name:EGAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:443 NORTHFIELD AVE
Mailing Address - Street 2:SUITE 201A
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-3093
Mailing Address - Country:US
Mailing Address - Phone:973-324-0103
Mailing Address - Fax:973-718-4611
Practice Address - Street 1:443 NORTHFIELD AVE
Practice Address - Street 2:SUITE 201A
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-3093
Practice Address - Country:US
Practice Address - Phone:973-324-0103
Practice Address - Fax:973-718-4611
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2009-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA62364208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJG94199Medicare UPIN