Provider Demographics
NPI:1477699544
Name:EISNER, FRED R (PHD)
Entity Type:Individual
Prefix:DR
First Name:FRED
Middle Name:R
Last Name:EISNER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 GORDONS CORNER RD
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:MANALAPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726-3342
Mailing Address - Country:US
Mailing Address - Phone:732-446-7167
Mailing Address - Fax:732-446-6287
Practice Address - Street 1:225 GORDONS CORNER RD
Practice Address - Street 2:SUITE 2A
Practice Address - City:MANALAPAN
Practice Address - State:NJ
Practice Address - Zip Code:07726-3342
Practice Address - Country:US
Practice Address - Phone:732-446-7167
Practice Address - Fax:732-446-6287
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00278400103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
172587Medicare UPIN