Provider Demographics
NPI:1790820819
Name:DEBORAH EISEN MD PC
Entity Type:Organization
Organization Name:DEBORAH EISEN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:EISEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-818-9400
Mailing Address - Street 1:530 LAKEHURST RD
Mailing Address - Street 2:SUITE 306
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-8063
Mailing Address - Country:US
Mailing Address - Phone:732-818-9400
Mailing Address - Fax:732-818-0210
Practice Address - Street 1:530 LAKEHURST RD
Practice Address - Street 2:SUITE 306
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-8063
Practice Address - Country:US
Practice Address - Phone:732-818-9400
Practice Address - Fax:732-818-0210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA06408000207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ879993Medicare ID - Type Unspecified