Provider Demographics
NPI:1508956533
Name:HANSEN, ERIC ANDREW (DO)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:ANDREW
Last Name:HANSEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 483
Mailing Address - Street 2:
Mailing Address - City:CAPE MAY COURT HOUSE
Mailing Address - State:NJ
Mailing Address - Zip Code:08210-0483
Mailing Address - Country:US
Mailing Address - Phone:609-465-0678
Mailing Address - Fax:609-465-9958
Practice Address - Street 1:8 COURT HOUSE-SOUTH DENNIS ROAD
Practice Address - Street 2:
Practice Address - City:CAPE MAY COURT HOUSE
Practice Address - State:NJ
Practice Address - Zip Code:08210-1967
Practice Address - Country:US
Practice Address - Phone:609-465-0678
Practice Address - Fax:609-465-9958
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB071862207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8561401Medicaid
H41677Medicare UPIN
NJ8561401Medicaid
NJH41677Medicare UPIN