Provider Demographics
NPI:1417124579
Name:ERIC R. NISENSON
Entity Type:Organization
Organization Name:ERIC R. NISENSON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:R
Authorized Official - Last Name:NISENSON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:973-539-7550
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-08
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00148000332B00000X
VT0560000179332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0946670001Medicare NSC