Provider Demographics
NPI:1285640037
Name:EIRAS, EMILIA C (MD)
Entity Type:Individual
Prefix:
First Name:EMILIA
Middle Name:C
Last Name:EIRAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:702 BREWERS BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08527-2020
Mailing Address - Country:US
Mailing Address - Phone:732-905-9630
Mailing Address - Fax:732-905-0837
Practice Address - Street 1:702 BREWERS BRIDGE RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:NJ
Practice Address - Zip Code:08527-2020
Practice Address - Country:US
Practice Address - Phone:732-905-9630
Practice Address - Fax:732-905-0837
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA040189207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1109804Medicaid
NJC57032Medicare UPIN
NJ554099NXWMedicare ID - Type Unspecified