Provider Demographics
NPI:1922012335
Name:EAGLE, ROBERT SELIG (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:SELIG
Last Name:EAGLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 S JEFFERSON ST
Mailing Address - Street 2:STE. 1
Mailing Address - City:ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07050-1562
Mailing Address - Country:US
Mailing Address - Phone:973-677-3466
Mailing Address - Fax:973-677-2362
Practice Address - Street 1:405 NORTHFIELD AVE
Practice Address - Street 2:STE. LL3
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-3026
Practice Address - Country:US
Practice Address - Phone:973-731-7961
Practice Address - Fax:973-731-9855
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04064300207R00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0537608Medicaid
NYRE011D1610OtherEMPIRE BCBS
NJ1K9725OtherHEALTHNET
854261OtherAMERIHEALTH
NJ1K9725OtherHEALTHNET
854261OtherAMERIHEALTH
NJ0537608Medicaid