Provider Demographics
NPI:1639514169
Name:JOHN, EIRENE GEORGE (MD)
Entity Type:Individual
Prefix:DR
First Name:EIRENE
Middle Name:GEORGE
Last Name:JOHN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20-20 FAIR LAWN AVE
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-2300
Mailing Address - Country:US
Mailing Address - Phone:201-703-0202
Mailing Address - Fax:
Practice Address - Street 1:20-20 FAIR LAWN AVE
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-2300
Practice Address - Country:US
Practice Address - Phone:201-703-0202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-10
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09953300207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine