Provider Demographics
NPI:1942252374
Name:EATMAN, FLORENCE B (MD)
Entity Type:Individual
Prefix:DR
First Name:FLORENCE
Middle Name:B
Last Name:EATMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 443
Mailing Address - Street 2:
Mailing Address - City:SOUTH ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07079-0443
Mailing Address - Country:US
Mailing Address - Phone:973-761-6203
Mailing Address - Fax:973-761-4347
Practice Address - Street 1:20 VALLEY ST
Practice Address - Street 2:SUITE 320
Practice Address - City:SOUTH ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07079-2887
Practice Address - Country:US
Practice Address - Phone:973-313-1113
Practice Address - Fax:973-761-4347
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2016-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA044211207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3281302Medicaid
NJC53797Medicare UPIN
NJ185824Medicare ID - Type Unspecified