Provider Demographics
NPI:1346402104
Name:ATIENZA, EDEN BAUTISTA (MD)
Entity Type:Individual
Prefix:DR
First Name:EDEN
Middle Name:BAUTISTA
Last Name:ATIENZA
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 1:41 S HEATHCOTE AVE
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08817-4744
Mailing Address - Country:US
Mailing Address - Phone:732-287-3416
Mailing Address - Fax:
Practice Address - Street 1:41 S HEATHCOTE AVE
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08817-4744
Practice Address - Country:US
Practice Address - Phone:732-287-3416
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-01
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04360400207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine