Provider Demographics
NPI:1700194099
Name:ASSOCIATES IN FAMILY AND GERIATRIC MEDICINE LLC
Entity Type:Organization
Organization Name:ASSOCIATES IN FAMILY AND GERIATRIC MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:EISENSTAT
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:908-688-4845
Mailing Address - Street 1:1050 GALLOPING HILL RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-7983
Mailing Address - Country:US
Mailing Address - Phone:908-688-4845
Mailing Address - Fax:
Practice Address - Street 1:1050 GALLOPING HILL RD
Practice Address - Street 2:SUITE 202
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-7983
Practice Address - Country:US
Practice Address - Phone:908-688-4845
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-20
Last Update Date:2010-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB04663300207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ25MB04663300OtherNJ LICENSE