Provider Demographics
NPI:1407992126
Name:NISENSON, ERIC ROBERT (DPM)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:ROBERT
Last Name:NISENSON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 SEDGEFIELD DR
Mailing Address - Street 2:
Mailing Address - City:MORRIS PLAINS
Mailing Address - State:NJ
Mailing Address - Zip Code:07950-3032
Mailing Address - Country:US
Mailing Address - Phone:973-539-7550
Mailing Address - Fax:973-539-1395
Practice Address - Street 1:3 SEDGEFIELD DR
Practice Address - Street 2:
Practice Address - City:MORRIS PLAINS
Practice Address - State:NJ
Practice Address - Zip Code:07950-3032
Practice Address - Country:US
Practice Address - Phone:973-539-7550
Practice Address - Fax:973-539-1395
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00148000213E00000X
VT0560000179213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1742400Medicaid
VTOVN3362Medicaid
VTOVN3362Medicaid
VTVN3362Medicare ID - Type UnspecifiedMEDICAR VT
NJ1742400Medicaid
NJT45371Medicare UPIN
VTOVN3362Medicaid