Provider Demographics
NPI:1538142187
Name:EZON, FREDERICK CHAIM (MD)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:CHAIM
Last Name:EZON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 HIGHWAY 35
Mailing Address - Street 2:
Mailing Address - City:OCEAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07712-4048
Mailing Address - Country:US
Mailing Address - Phone:732-531-8200
Mailing Address - Fax:732-531-8201
Practice Address - Street 1:1025 HIGHWAY 35
Practice Address - Street 2:
Practice Address - City:OCEAN
Practice Address - State:NJ
Practice Address - Zip Code:07712-4048
Practice Address - Country:US
Practice Address - Phone:732-531-8200
Practice Address - Fax:732-531-8201
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-28
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03285800207Y00000X
NJMA32858173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ383640102Medicaid
NJ383640102Medicaid
NJ074241Medicare PIN