Provider Demographics
NPI:1942386123
Name:EPSTEIN INTERNAL MEDICINE
Entity Type:Organization
Organization Name:EPSTEIN INTERNAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:CHER
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-764-4115
Mailing Address - Street 1:2906 ROUTE 130 SOUTH
Mailing Address - Street 2:STE 201
Mailing Address - City:DELRON
Mailing Address - State:NJ
Mailing Address - Zip Code:08057-2521
Mailing Address - Country:US
Mailing Address - Phone:856-764-4115
Mailing Address - Fax:856-764-4116
Practice Address - Street 1:2906 ROUTE 130 SOUTH
Practice Address - Street 2:STE 201
Practice Address - City:DELRON
Practice Address - State:NJ
Practice Address - Zip Code:08057-2521
Practice Address - Country:US
Practice Address - Phone:856-764-4115
Practice Address - Fax:856-764-4116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB07370900207Q00000X
NJ25MA05429000207R00000X
NJ26NJ00038200207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5089409Medicaid
NJ688849Medicare ID - Type Unspecified
E98998Medicare UPIN