Provider Demographics
NPI:1578881090
Name:EASTERLING, TORIAN J (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:TORIAN
Middle Name:J
Last Name:EASTERLING
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:183 SOUTH ORANGE AVE P.O BOX 1709
Mailing Address - Street 2:BHSB, E-1563
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07101-1709
Mailing Address - Country:US
Mailing Address - Phone:973-972-2495
Mailing Address - Fax:973-972-7997
Practice Address - Street 1:90 BERGEN ST
Practice Address - Street 2:STE 0300 LL
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07103-2425
Practice Address - Country:US
Practice Address - Phone:973-972-2111
Practice Address - Fax:973-972-2754
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-07
Last Update Date:2012-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYAPPLIED FOR207Q00000X
NJ25MA09174100207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine