Provider Demographics
NPI: | 1306868278 |
---|---|
Name: | STEVEN F EISEN DMDPA |
Entity Type: | Organization |
Organization Name: | STEVEN F EISEN DMDPA |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | PRESIDENT |
Authorized Official - Prefix: | |
Authorized Official - First Name: | STEVEN |
Authorized Official - Middle Name: | F |
Authorized Official - Last Name: | EISEN |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | DMD |
Authorized Official - Phone: | 732-449-1166 |
Mailing Address - Street 1: | 2130 HIGHWAY 35 |
Mailing Address - Street 2: | SUITE 121 |
Mailing Address - City: | SEA GIRT |
Mailing Address - State: | NJ |
Mailing Address - Zip Code: | 08750-1010 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 732-449-1166 |
Mailing Address - Fax: | 732-449-3344 |
Practice Address - Street 1: | 2130 HIGHWAY 35 |
Practice Address - Street 2: | SUITE 121 |
Practice Address - City: | SEA GIRT |
Practice Address - State: | NJ |
Practice Address - Zip Code: | 08750-1010 |
Practice Address - Country: | US |
Practice Address - Phone: | 732-449-1166 |
Practice Address - Fax: | 732-449-3344 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2006-07-23 |
Last Update Date: | 2020-08-22 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NJ | 13109 | 1223P0300X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 1223P0300X | Dental Providers | Dentist | Periodontics | Group - Single Specialty |