Provider Demographics
NPI:1851483655
Name:ROBERT EIDUS, M.D. P.A.
Entity Type:Organization
Organization Name:ROBERT EIDUS, M.D. P.A.
Other - Org Name:CRANFORD FAMILY PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:EIDUS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:908-272-7990
Mailing Address - Street 1:123 N UNION AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:CRANFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07016-2198
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:123 N UNION AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:CRANFORD
Practice Address - State:NJ
Practice Address - Zip Code:07016-2198
Practice Address - Country:US
Practice Address - Phone:908-272-7990
Practice Address - Fax:908-272-7970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03034900207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJC53658Medicare UPIN