Provider Demographics
NPI:1275582157
Name:AVERSA, EILEEN (NP)
Entity Type:Individual
Prefix:
First Name:EILEEN
Middle Name:
Last Name:AVERSA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:EILEEN
Other - Middle Name:
Other - Last Name:AVERSA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DNP
Mailing Address - Street 1:3600 ROUTE 66 STE 400
Mailing Address - Street 2:
Mailing Address - City:NEPTUNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07753-2645
Mailing Address - Country:US
Mailing Address - Phone:732-363-6655
Mailing Address - Fax:732-363-6656
Practice Address - Street 1:2106 NEW RD STE D4
Practice Address - Street 2:
Practice Address - City:LINWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08221-1050
Practice Address - Country:US
Practice Address - Phone:609-926-8899
Practice Address - Fax:609-926-6474
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00043200363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily